c c<< *<?< 



5 CO 






c c c<; 



jC 




<X < 


V 


<1- ' 


<**SK'< 


cC 4 


V 






/-^ tf 


<r 


< 




< < 




=- <: 


c &?£« 


< 


* 


2 * 


<■< < ' 










c«c 






< €L«C C 



r<c«s c 



.G-^^^'SS^ '%>*«>< 



«ms« 



,;< cccc< - 

<<rcc 
OCCC 

OCC-C ■-. 

tv ccccc 



{■LIBRARY OF CONGRESS.} 

J, - — | 

Mlmp |°l?2"9 M |' a # 

i r ^i C- I J 

! UNITED STATES OF AMERICA.} 



ccCfttC,^ 












SS^S 


















cc 






^c^s^^ 



3C<i 









<?: cic ;'c* c_s* 



Si v< 









<A< «Cj 






<r c < 
ant < 



vsrlc c3r< 



cx„<3Kj c<?? c<^ > 



r \ «s:<: r - < * at? «..«: <: 

.5 c ^<-3tsjs&Mat<-' 



ocro c« 



<T c 



cccccv 

<L «d c<? < c - 

c d < <: <: < l • • CC 



LX C <- «fc< 



: c cc< <r C< c 

COK.C C^ 



"«L- C^v C 









l<£KC« 






J 


Eg <■ < 
BT r -< < 

7* <1 .<■ C * 




yp~ 


<c c <r 


6SLC^- 


Cj : 


c Cc: C <cc 


(C<^ s 


C3T* % 


c <r •<:<: 


cCCC c 


C" < 


c c «rc 


^CCf f' 1 


^ 


^ C c d< 


cC3/ <-' 






From the Fifth Annual Report of the State Board of Health. 

/ 



POLITICAL ECONOMY 



HEALTH. 



By EDWARD JAR VIS, M. D. 

OF DORCHESTER. 



BOSTON : 

WRIGHT & POTTER, STATE PRINTERS, 

.79 Milk Street, Corner of Federal. 

1874. 



POLITICAL ECONOMY OP HEALTH. 



By EDWARD JARVIS, M. D., of Dorchester. 



# 



POLITICAL ECONOMY OF HEALTH. 



Health is the Capital of the Laboring Man."— Latham.* 



In estimating the power or the value of a state or nation, 
two factors are commonly used, — 

1. The number of the people. 

2. The value of their property. 

In the first the people are simply counted; men, women 
and children, — all have equal share in this enumeration ; the 
infant and the mature, the strong and the weak, the healthy 
and the sick, are all presumed to contribute an equal portion 
to the body politic. 

Numbers have, in themselves, no power. They are merely 
representatives of things that may be nominally alike, but 
infinitely various in their degrees of value. 

A community of children in the forming stages of life, or of 
invalids, or of patients in hospital, or lunatics, is very differ- 
ent from one that includes only persons in the mature and 
effective periods of life. 

As the nation's wealth consists of the sums of all the estates 
within its borders, the great and the small, deducting all 
incumbrances, mortgages, debts, etc., so the strength of the 
state is the sum of all the effective people, deducting all the 
personal incumbrances, sicknesses, disabilities, and imper- 
fections. 

Thus, the state that has the largest proportion of its people 
in the years of maturity, from twenty to seventy, is stronger 

* Sanitary Engineering. 



336 STATE BOARD OF HEALTH. [Jan. 

and wiser than one that has a larger proportion in the imma- 
ture period of childhood and youth ; and one, all of whose 
members are in fulness of health and strength, is stronger 
than one, any of whose people are disabled with fever, con- 
sumption, lunacy, intemperance, etc. 

Every increase of individual estate, every dollar earned, 
and every new value created, is so much addition to the com- 
mon wealth, and every detraction from the wealth of individ- 
uals, ^every dollar that is expended without return, wasted or 
squandered, every extinguishment of any value, is so much 
taken from the public capital ; and all incumbrances, debts, 
mortgages on property of persons, must be deducted from the 
sum total (ft the common wealth, in order to obtain a true 
estimate of its worth. 

So all additions to the physical, moral or intellectual power 
of individuals, all strengthening of the arm and increased 
skilf ulness of the hand, all culture of the brain, sharpening of 
the perceptive faculties, or discipline of the reflective and 
reasoning powers, in any individual, are, to that extent, ad- 
ditions to the energy and the productive force, the effectiveness 
and the wisdom of the state ; and, on the contrary, all deduc- 
tions from these forces, whether of mind or body, every sick- 
ness, any injury or disability, every impairment of energy, 
every clouding of the brain from intoxication, all waste of 
mental discipline, take so much from the mental force, the 
safe administration of the body politic. Collective personal 
gain is public gain, and aggregate personal loss is, to the same 
extent, the suffering of the community. 

The State thus has an interest, not only in the prosperity, but 
also in the health and strength and effective power of each one 
of its members ; and it has a claim upon all to develop their 
estates and themselves, bodily and mentally, to the greatest 
extent, and add each one to the aggregate wealth and power 
of the whole. 

The period of development is from birth to the completion 
of the twentieth year. From twenty to seventy is the period 
of maturity and efficiency. From seventy and upwards is the 
period of old age, when men rest from their labors. 



$ 



The years of growthftof old age, constitute the dependent 



1874.] STATE BOARD OF HEALTH. 337 

periods. The years of maturity, from twenty to seventy, are 
the sustaining period. 

The labors of these fifty years — twenty to seventy — create 
substance sufficient, not only for the support of the worker of 
that time, but for the early years of growth, and also the 
ordinary period of decrepitude, after seventy.* 

The effective power of a nation is in the number of its peo- 
ple in the sustaining period, and in the proportion these bear 
to the dependent classes. In all the United States, among 
the whites, 49 per cent, are in the sustaining class, j- and 51 
per cent, in the dependent. Among the colored the propor- 
tions were 44.78 per cent, supporters, and 55.22 consumers. 
A wide difference in this respect is seen in comparison of the 
Northern States with those of the South. In Vermont the 
sustaining classes are 53 per cent., and in Massachusetts, ow- 
ing, in part, to immigration, 56.8 per cent., while the depend- 
ent classes in these States are, severally, 47 and 43 per cent. 
On the contrary, the sustaining classes in North and South 
Carolina are 46, and in Georgia 47 per cent., while the classes 
depending on others for support are 53 and 56 per cent. 

A similar difference is found in analyzing the populations of 
Europe. The following table shows, at a glance, the propor- 
tions of the sustaining and dependent classes in various 
countries. 



* These are general averages, not applicable to every Individual. Many earn suffi- 
cient for their support, under the direction of others, before they are twenty years old ; 
but even these are not contributors beyond their consumption to the public capital. 
As a class, they do not mature until this period is passed. On the opposite extreme 
of life, some retain their strength and labor after passing then- seventieth year; but 
more begin their rest in decrepitude before that age. 

f This is due, in some measure, to foreign immigration, which bxings a large pro- 
portion in the middle period of life,— twenty to forty years old. 
43 



338 



STATE BOARD OF HEALTH. 



[Jan, 



Proportions of the Sustaining and Dependent Classes.* 



NATION OR STATE. 



France, . 

Massachusetts (white) 

Switzerland, . 

Belgium, 

Sweden, 

Denmark, 

Spain, . 

Holland, 

Prussia, . 

Vermont, 

England, 

Scotland, 

Norway, 

United States (white), . 

South Carolina (white), 

North Carolina (white), 

Ireland 

United States (colored), 
Georgia (white), . 



1866 
1870 
1861 
1856 
1860 
1860 
1858 
1859 
1869 
1870 
1861 
1851 
1865 
1870 
1870 
1870 
1841 
1870 
1870 



60 32 
56 80 
56.20 
54.61 
54.51 
54.30 
53.46 
53.52 
52.62 
53 30 
52.21 
51.30 
50.78 
49.04 
46.70 
46.04 
46.50 
44.80 
44.40 



Dependent. 


© 
w 

S 

c 


3 

6 




36.09 


3.64 


39.68 


4D.30 


2.80 


43.10 


41.22 


2.58 


43.60 


42.51 


2.88 


45.39 


42.67 


2.82 


45 49 


42.76 


2.94 


45.70 


44.66 


1.48 


46.14 


44.15 


2.33 


46.48 


45.34 


2.03 


47.37 


42.50 


4.50 


47.00 


45.04 


2.74 


47.78 


45.00 


2.95 


48.55 


45.44 


3.77 


49 21 


49.18 


1.80 


50.98 


51.20 


1.90 


53.10 


51.70 


2.06 


53.96 


52 03 


1.48 


53.51 


53.60 


1.50 


55.10 


53.90 


1.50 


55.40 



657 

759 

779 

831 

834 

845 

863 

868 

880 

900 

915 

946 

969 

1,039 

1,136 

1,153 

1,201 

1,229 

1,248 



* From the censuses of these nations and states. 



Thus it is seen that the effective force of the nation is not 
represented by the total number of the people, but by the 
number in the effective or productive age, and this is again 
qualified by the burden of supporting the dependent classes, 
which are constantly with them. 

It appears from this analysis, that there is a wide difference 
in both these respects between different countries. 

The proportion of the sustaining class in France exceeds 
that in Ireland by 35 per cent. The proportion in Massachu- 
setts exceeds that of the whites in the Carolinas and Georgia 
by 38 per cent., and in England it is 12.9 per cent, greater 
than in Ireland. 

Comparing the sustaining power with the burden laid upon 
it, the demand was 94 per cent, greater in Ireland than in 
France. On the whites, it was in the Carolinas 50 per cent., 
and in Georgia 60 per cent, greater than on the people of 
Massachusetts. 



1874.] 



STATE BOARD OF HEALTH. 



339 



Ideal Life. 

In the ideal state of vitality, which now falls to the lot of 
some individuals, but not on the whole community, all that 
are born survive to enter the matured stage of life ; all who 
enter this stage labor through it, and then live to their four- 
score and first year. In such a population of 80,000, there 
are 20,000 in the forming period, 50,000 in the productive or 
effective period, and 10,000 in old age. The labor of five 
years supports eight. In the effective period, the man pro- 
vides sustenance, not only for himself while laboring, but for 
his children, and for himself when past labor. 

This is far from being the common lot of man. Every- 
where and in every age human life is arrested. 

The following table shows the proportion of 10,000 born in 
each country that reach maturity and fulness of age : — 

Of 10,000 born : * 



COUNTRY. 



Survive 20. 



Norway, . 

Sweden, . . . 

England, 

United States (males), 

Hanover, 

France, . 

Ireland, . 




Survive 70. 



3,487 
2,557 
2,379 
2,559 
1,607 
1,176 
861 



Beside the natural love of lijfo, and the comfort and happi- 
ness from length of years, wn>ch all hope to enjoy, the State 
has an interest that all should reach maturity, and then labor 
and contribute to the common strength and wealth as long as 
possible. 




* Calculated from the National Life Tables. 

Norway. — " Norges omcielle Statistik, Folkmcengdens Bevosgelse," 1856-65, p. 217. 

Sweden.—" Sveriges Officiela Statistik, Befolknings Statistik," 1856-60, p. 75. 

England.—" English Life Table No. 3, p. 24. Dr. Farr in Registrar-General's Re- 
port, 1864." 

Hanover. — " Bevolkerung und den Lebensdauer," 1846. Ta. B. xxvii. 

Ireland. — Census of Ireland, 1844, p. lxxx, &c. 

United States. — L. W. Meech — Life Table Males, in Insurance Report, Mass., 1868, 
p. ciii. 



340 STATE BOARD OF HEALTH. [Jan. 

In this economical view, man may be considered as a pro- 
ductive machine, which creates property or sustenance for 
itself and the Commonwealth. Then a child that is born is 
but a vital machine begun. But it is powerless and ineffect- 
ive, and must be built up and developed and grown and 
trained for work. This is a perilous and doubtful process of 
twenty years. 

It seems, by table on page 339, that in Norway, the most 
favored country, 25 per cent, perish in the forming period. 
In the United States, 35 per cent, of the males, and in 
Ireland, 51 per cent., fail to reach maturity. In Norway, 
only 34 per cent. ; United States, 24 per cent. ; and in Ire- 
land, less than 9 per cent, enjoy the full period of working 
years. 

In the ideal state, every twenty years expended in the 
development of manhood and womanhood, results in the 
completion of a matured laborer. But in the actual ex- 
perience of the world, a varied portion of this expenditure is 
lost by death in this period. 

In the production of dead machinery, the cost of all that 
are broken in the making is charged to the cost of those 
which are completed, and the prudent manufacturer charges 
all that he expends on the failures to those that succeed, as a 
proper part of the cost. Thus, if two fail, when half finished, 
for every one that is completed, the cost of the finished one 
is doubled ; and this increase of cost is in proportion to the 
expenditure which has been made or lost on those that broke 
down in the process. 

So in estimating the cost of raising children to manhood, 
it is necessary to include the number of years that have been 
lived by those that fell by the way, with the years of those 
that pass successfully through the period of development. 
With this view, the following table has been prepared to show 
the number of years that were lived by children and youth 
under twenty, for every 1,000 that reached the fulness of 
maturity : — * 

* Calculated from the Life Tables. 



1874.] 



STATE BOARD OF HEALTH. 



341 





COUNTRY. 


Years spent 
under 20. 


Per cent. Loss. 


Norway, . 




2,142 


7.1 


Sweden, . 




2,182 


9.1 


England,. 




2,192 


9.6 


America, . 




2,233 


11.16 


United States, . 




2,251 


12.55 


France, . 




2,327 


16.35 


Ireland, . 




2,514 


25.70 



As the great majority of those who were lost died in 
infancy and early childhood, the sum of the years that they 
had lived was small compared with that of those who passed 
safely through the whole period. But yet there is a great 
difference in this respect in these several countries. The 
loss iu Ireland was 120 per cent, greater in the first year, 75 
per ceut. in the first five years, and 120 per cent, greater in 
the period of growth, than in Norway. 

Financial Yiew t . 

Beside the pain, anguish and sorrow caused by these early 
deaths, they deeply concern the State as a matter of political 
economy. 

Simply as a vital productive machine, a child at any age is 
worth the cost that has been expended on him for his support 
and development. The cost of the support and training of 
children is widely various, from that which sustains bare 
animal life, to the lavish luxury of the opulent; but taking 
the lowest estimate for the laboring population, it, on an 
average, costs not less than fifty dollars a year. Then a 
child of ten is worth $500; and at maturity $1,000, and the 
death of either of these is so much loss to the Commonwealth. 

Both English and German political economists calculate the 
value of man at all ages, from childhood to old age, and 
come to similar conclusions from very different bases. 



Death of Children and Youth in Massachusetts 
By the Thirtieth Report of Mortality of Massachusetts, 
page 146, we find that in the seven years, ending with 1871, 



342 STATE BOARD OF HEALTH. [Jan. 

81,029 died under twenty in the State. Their ages are all 
given in years to the fifth, and in quinquennial periods, from 
five to twenty. With these facts and the life table, it appears 
that the whole sum of their lives amounted to 292,762 years, 
which, at $50 a year, had cost $14,638,100. This sum had 
been paid from the estates, income or earnings of their fami- 
lies, and diminished to that extent the income or the capital 
of the Commonwealth. This sum, invested in the life of these 
81,029 children and youth, was lost in the course of seven 
years, and so much, or an annual average of $2,109,157, was 
lost to the State by premature death. 

The blessing which these perishing children were to their 
families in their shortened lives, cannot be measured nor told 
in any language ; the heart alone knows the jo} r at their ap- 
pearing and the agonizing sorrow at their early departure. 
But the Commonwealth only knows these as the promise of 
usefulness which was not and never can be fulfilled. 

Working Years. 
The life tables of the several nations show that all fall short 
of their ideal in various degrees. The average duration of 
effectiveness enjoyed by the people, between twenty and sev- 
enty was,* in — 

Norway, . . . . . 39.61 years. 

Sweden, . . . . . 38.10 

United States, males, . . . 37.46 

Hanover, . . . . . 35.81 

England, 35.55 

France, 32.84 

Ireland, . . . . . 28.88 

Thus the productive efficiency fell short of its fulness 20.78 
per cent, in Norway, 23.7 per cent, in Sweden, 25.08 per 
cent, in the United States, 28.38 per cent, in Germany, 28.9 
per cent, in England, 34.3 per cent, in France, and 42.24 
per cent, in Ireland. 

* Calculated from Life Tables. 



1874.] STATE BOAED OF HEALTH. 343 

Death in Working Peeiod in Massachusetts. 
In Massachusetts, during the seven years, 1865 to 1871, 
72,727 died in their working period. In the fulness of health 
and completeness of life, they would have had opportunity 
of laboring for themselves, their families and the public, in 
all 3,606,350 years, but the total of their labors amounted 
only to 1,681,125 years, leaving a loss of 1,925,224 by their 
premature death. This was an average annual loss of 276,461 
years of service and cooperation. Thus it appears that in 
Massachusetts, one of the most favored States of this country 
and of the world, those who died within seven years had con- 
tributed to the public support less lhan half, 46.07 per cent., 
of what is done in the best conditions of life. 

Sickness. 

Nor is this loss by early death all that the Commonwealth 
suffers in diminution of productive power in their period 
presumably devoted to profitable labor. Even while men 
and women live they are subject to sickness, which lays a 
heavy tax on their strength and effectiveness. 

No exact account has been yet taken of the amount of sick- 
ness in this country. But the experience and investigations 
of other nations enable us to approximate this matter. In 
Great Britain there are many organizations under various 
forms and names, as Benefit Societies, etc., which include 
many hundred thousand members of all ages. A prominent 
purpose of their association is to support each other, when 
deprived of the power of labor by sickness. For this pur- 
pose, each member makes certain contributions weekly or 
monthly to a common fund, and in return receives a certain 
weekly amount, varied according to the contribution or other 
circumstances, when sick or otherwise disabled from labor. 
The treasurer takes account and makes record of the time 
and duration of the sickness or disability, with other facts, as 
age, sex, disease, the occupation of the applicant, etc. By 
this means a full record is made of all the sickness and inju- 
ries of a very large portion of the men, women and children 
in every part and in all the employments of the kingdom. 

The government, wishing to measure the productive power 



344 STATE BOARD OF HEALTH. [Jan. 

of the people, gathered these records, made through many 
years, and placed them in the hands of the best investigators 
and calculators to analyze and combine them and show the 
proportion and amount of sickness that fell on males and 
females, children and adults in every age from childhood to 
the last years of life, and in the various occupations and con- 
ditions of society. The results of these labors are published 
in the Parliamentary Reports on Benefit Societies. Finlaison, 
Neison, Ansel, Macullagh and other statisticians have writ- 
ten very instructively on this subject. Thus the amount of 
sickness and the proportions of time lost in consequence of 
sickness or disability at each age is shown as it existed 
through many years, and is the basis of expectation for people 
in like conditions and circumstances. It is not to be sup- 
posed that every individual will have just his quota of sick- 
ness in every year, nor is it said that this has been each one's 
experience. But these are the averages of all. 

American Health Assurance Companies. 

Some years ago there were several Health Assurance Com- 
panies in operation in this country, offering for certain pre- 
miums, varied according to age and circumstances, to be paid 
at fixed periods, to pay out certain amounts a week, whenever 
the assured should be sick. For want of any record or knowl- 
edge of the experience of the people in this country, they 
assumed the British rates as their guide in fixing the amounts 
that should be paid in as premiums and returned in time of 
sickness. On this basis they adjusted the rate of premium 
and relief in such a manner as they supposed would leave the 
companies a reasonable profit. But unfortunately, in the re- 
sult, there was not only no profit, but a loss, and the compa- 
nies were compelled to close their offices and cease to insure. 
The premiums paid in were insufficient for the allowances 
promised in the time of sickness. The demands were greater 
than they had calculated ; there was more sickness than the 
British records showed as their experience in England and 
Scotland. 

It is safe, then, to assume that the amount of sickness or 
disability is, at least, as great in the United States as it is in 
Great Britain, and the rates found in the British reports may 



1874.] STATE BOARD OF HEALTH. 345 

be used as a means to determine or approximate the amount 
of sickness in Massachusetts among the people of the work- 
ing age, 20 to 70. 

At the last census, in 1870, there were 796,252 of this 
class in this State. The British rates of sickness for each 
sex, at each age, are given by Finlaison,* in days for the 
males, and in weeks and fractions of a week, by Neison,| for 
the females. 

Applying these several rates, in each of the quinquennial 
periods from 20 to 70, to the population of Massachusetts in 
1870, it appears that there was in that year among the people 
of the working productive age a total amount of 24,553 years 
and eight months sickness or disability, when so much oppor- 
tunity for labor was lost to our people. 

This is not all the loss of labor and production by means 
of sickness. These rates are from records of the treasurers 
of the benefit societies of the periods during which they paid 
money in aid of the sick members. Their rules allow no 
payment for periods short of a full week. It is presumed 
that for a disablement of a period less than a week the mem- 
bers can take care of themselves, and will need no aid from 
the society. The records, then, do not include the manifold 
lesser ailments that are frequently occurring, — colds, headache, 
temporary rheumatism, slight injuries, toothache, — which sus- 
pend the power of labor for one, two or more days, yet less 
than a week, and therefore not recorded. Beside these there 
are many slight ailments that are insufficient to confine one 
to the house, or even keep him from his workshop, yet im- 
pair his energy and lessen the effectiveness of his exertions. 

There is another and remarkable exception to the fulness 
of the reports of sickness. The government report says that 
in this analysis, "nothing but sickness, in the true sense of 
the word, — that is, sickness incapacitating from labor, and 
requiring constant medical treatment, and of limited duration, 
as contra-distinguished from chronic ailment, and mere 
decreptitude, — was considered to be sickness ; for instance, 
slight paralysis, blindness, mental disorder or senile infirmity 

* Parliamentary Report on Sickness in the Friendly Societies, August 16, 1853, p. 
xxvii. 
f Contributions to Vital Statistics, p. 410. 
44 



346 STATE BOARD OF HEALTH. [Jan. 

cannot, it was thought, be fairly classed with the sickness 
commonly prostrating the workman, and for relief under the 
ministrations of which he seeks the aid of a benefit- club."* 

It is manifest, then, that very much of the disability that 
prevents work and causes loss of production is not in the 
record, and that much of the actual loss, by impaired health 
and energy, fails to be noticed in the calculation, and is there- 
fore not included in the rates herein quoted from the British 
reports. 

There is another consideration. These friendly societies, 
being practically health insurance companies, must sustain 
themselves, and make their payments out of constant and 
sufficient assessments. They are not charitable institutions, 
except so far as the recipient of charity and aid has already 
paid that which he asks. None but those who can make the 
regular payments are admitted ; and none are retained, 
except as long as they comply with the conditions of unfailing 
contributions. Hence the poorest, the idle, the profligate, 
the intemperate, those who earn but little, or who spend their 
earnings in drinking, are excluded, or, if admitted, are 
dropped from the roll. These are the classes who have the 
most sickness. The same rule would exclude many feeble 
lives, — persons suffering from hereditary disease or chronic 
ailments, — consumption, asthma, epilepsy, — who either never 
had health sufficient to become contributors, or fail to ask for 
admission before they became so impaired. 

From all these causes and conditions, a large portion of the 
disabilities of the people does not appear on their records, 
and the rates which are found on the tables, on which these 
societies base this class of their operations, and on which our 
health assurance companies endeavored to carry on their 
work, do not signify the whole extent of the disabilities, either 
there or here. 

It is estimated by the English observations and calculations 
that for every death there are two constantly sick ; that is, 
730 days' sickness and disability for every death. 

It appears, then, that in Massachusetts, in 1870, there was 
a loss in the effective period equal to 276,461 years by prema- 

* Pari, paper, August 12th, 1853. 



1874.] STATE BOAKD OF HEALTH. 347 

ture death, and 24,553 years by sickness, making 301,014 
years' loss of force on productive power in a single year. 
There was the same proportionate loss in the previous year, 
and there is no reason to hope that it will not be the same in 
ratio of the numbers of the living for years to come, unless 
some happy change shall come over the sanitary habits and 
condition of our people. 

Comparison of Periods of Development and Labor. 

If there were no deaths in this period of growth, — if none 
fell in the process of development, and none in the effective 
period, — then every twenty years expended in the early stage 
would produce a mature man or woman, and be followed by 
fifty working years. But, as already seen, much time is 
expended on those that are lost in the period of growth, and 
the period of labor is shortened by the deaths between 20 
and 70. Having the number that are lost in the maturing 
period, and the number of years that they have lived, and 
also the number that die in the effective stage, and the dura- 
tion of their labors, it is easy to draw a comparison between 
them, and show the cost, in years, of creating and maturing 
human power, and the return which it makes in labor in 
compensation. 

By this double measurement of life, in its incompleteness 
and in its fulness, it is found that for every 1,000 years 
expended in the developing period, upon all that are born, both 
those who die and those w 7 ho survive the period from birth to 
20, the consequent laboring and productive years are, — 



In Norway . 


1,881 years.* 


Sweden, . 


1,749 " 


England, . 


1,688 " 


Hanover, 


1,686 « 


United States, males, 


1,664 " 


France (1806), 


1,398 " 


Ireland (1841), 


1,148 " 



It costs less to develop a man in Norway than in any other 

* Calculated from Life Tables. 



348 STATE BOARD OF HEALTH. [Jan. 

country. It was shown in the article on Infant Mortality,* 
that a larger proportion of infants survived their first year in 
Norway than elsewhere, and these children, when grown, 
have the greatest power of endurance that the records of life 
and death reveal. Comparing those people who are thus 
endowed with persistent vitality with those of the opposite ex- 
treme, — the Irish at home, — it is seen that a thousand years 
spent in the growing period produce 63 per cent, more of 
working life among the Scandinavians than among the Celts. 
In this respect the Norwegians are 13 per cent, more favored 
than the Americans, and the Americans 44 per cent, more 
favored than the people of Ireland. 

The World's Work done between Twenty and Seventy. 
In this period of life, — twenty to seventy, — shortened as it 
is by premature death and weakened by sickness, all the work 
of the world is planned, directed and performed. This age 
gives to the nation its physical and mental power, its wisdom, 
and its effectiveness. It directs the affairs, public and private. 
It earns the income, produces the sustenance, and creates the 
wealth. Nearly all the property, capital and value in the 
world are created by human power in this period. 

Nature and Man Partners in Creation of Wealth. 

In this work — the creation of wealth — nature and man are 
joint partners and cooperate together. Nature contributes 
the material, man gives it value by putting it in such form, 
combinations and position as to make it available. The con- 
tributions of nature are worthless as they lie in her hands ; 
but they have a prospective value, in proportion as they can 
be manufactured, by the power and skill of man. 

The earth, air and water produce vegetation (tree, herb and 
fruit) , but these are useless, and nearly worthless, to the world 
until the human hand shall convert them and fit them for use. 
In the simplest matter of property, the tree standing in the 
forest has a small price. In Massachusetts, in various places, 
it is sold from fifty cents to two dollars a cord. The wood- 
man cuts it down and divides it into parts fit for transporta- 

* Massachusetts Fourth Report Board of Health,.1873, p. 193. 



1874.] STATE BOARD OF HEALTH. 349 

tion, and thus adds 50 to 100 per cent, to its value. The 
teamster carries it, on his sled or his wagon, to market, and 
thereby increases its value from $5 to $10 a cord ; the wood- 
sawyer then divides it into portions fit for burning, and then 
it is worth $7 to $12 a cord. Of all this value nature con- 
tributes but a small proportion, and the brain and muscle of 
man gives the rest. This disproportion of contribution is 
increased in the production of other forms of wooden merchan- 
dise. The fine woods — mahogony, rosewood, black walnut-— 
are found in distant forests, some, in the tropics, of difficult 
access. They are brought within the reach of mechanical art 
by ships, railroads and horses ; then they are wrought into 
furniture,' musical instruments and ornaments, with skill and 
force of handicraft; and when, at last, they appear in forms 
of chairs, bureaus," pianofortes, flutes, articles of graceful 
adornment, etc., they have a value in the market, compared 
with which its worth in the living forest is an almost inappre- 
ciable trifle. 

The metals in their manifold forms constitute a very large 
part of the world's pecuniary capital. Nature furnishes the 
original raw material of these in the ores of the earth. The 
ore of iron is often deep in the recesses of the ground, inac- 
cessible except through pits and shafts, which must be made 
by the power of human labor, digging through the loose 
earth and blasting through rocks. The ore is removed with 
great labor from its bed and brought to the surface of the 
earth, submitted to the process of metallurgy, and at length 
is made into bars for the smith's and the manufacturer's use. 
Finally, through the process of the shop and the factory, it is 
converted into articles of hardware, locks, nails, wheels, 
machinery, etc. In all these processes human skill and labor 
add so much to the value of the material, that what originally 
had hardly a price has become a small fortune. 

The " New American Cyclopedia" (IX. , 589) , says, a bar of 
iron worth $5 is worth $10.50 in horseshoes, $55 in needles, 
$3,285 in pen-knife blades, $29,480 in shirt buttons. In this 
property of $29,480 the iron represents only $5 and labor 
$29,475. And carrying the analysis of value farther back to 
the ore in its buried place in the earth before the soil had 
been removed from the surface, or the strata of rock blown 



350 STATE BOARD OF HEALTH. [Jan. 

and broken from about it, or even a road had been made from 
civilization to the ore-bed, it is manifest that human labor has 
given most of the value of the iron bar, and a few cents, more 
probably a few mills, would represent the total value of the 
ore in its original position. Then these few mills' worth of 
the natural ore is but the nucleus around which the labor of 
man may gather value a hundred fold, thousand fold, ten 
thousand fold ; and this is the proportion that the joint partners 
— nature and man — contribute to the capital finally vested in 
the merchandise of iron and steel. 

Buildings. 

The capital in buildings, dwellings, shops, factories, and of 
many other kinds, which is one of the great elements of the 
world's wealth, — these, like others herein mentioned, are the 
handiwork of man. 

Nature gave the lumber in the living tree, in the remote for- 
est; the marble, granite, sandstone; the lime for the mortar 
in the subterranean, and, in large portion, distant quarries ; 
the brick in the clay-pit ; the iron for the nails, screws, hinges, 
locks, etc. ; the copper, tin, lead and zinc, in the original ore 
in the earth ; the elements of the paints also in their raw and 
uncompounded state, before the mind of man had devised a 
way to reach them, or the hand of man had lifted a shovel, 
spade or pick-axe to take possession of them. It is plain that 
in this great property, as elsewhere, the analysis of the origin 
of value shows that it is nearly all the result of human labor, 
— the work of the hand guided by the brain. 
' * 
Effective Population in 1855, 1865 and 1870. 

In this State the numbers of the effective population were, — 

In 1855, 626,476* 

1865, 709,542* 

1870, 828,448| 

Who did, or presumptively could, by their labor, contribute 
to the income and capital of the Commonwealth. 

* State Census, 1855 and I860, 
t National Census. 



1874.] STATE BOARD OF HEALTH. 351 

Productions and Valuation of Massachusetts. 
In Massachusetts the total valuation of the taxable property 
was,* — 

In 1865, . . . . . $996,841,901 

1870, 1,417,127,376 

1872, 1,696*599,966 

The productions of industry, agricultural and mechanical, — 

In 1855, were .... $295,820,681f 
1865, " . . . . 517,240,613 

All these statements are but approximations to the truth. 
The valuation includes only the taxable property, and omits 
that which was not taxable. These exceptions are large. 
They include all public property, belonging to the State, 
counties and towns, public buildings, roads, streets, and 
United States bonds. 

These would swell the valuation to a much larger amount. 
But it is sufficient for the purpose to say that there was a cap- 
ital in the State amounting, in 1865, to $991,841,906 in the 
care of 709,542 people of the working age, and in 1870 there 
was a capital of $1,417,127,376 in the care of 828,448 people 
to use and utilize it, and that in 1865 these people produced 
or put in condition of use $517,000,000 worth of property. 
This was an average of $729 for each one between the ages of 
twenty and seventy. These amounts of production include 
both the estimated value of the raw material used *n»the cost 
of labor in the production, in the total value of the articles 
when they passed out of the hand of the manufacturers. 

In this way some articles are valued more than once, as the 
leather, which is valued and included in the productions of 
the tannery, passes into the hands of the ^oemaker and har- 
ness-maker and is again included in the production of shoes 
and harness factories. So also paper re-appears in publishers' 
productions; hinges, nails, screws, doors, sashes, blinds, 
etc., in the value of buildings ; cloth in clothing. 

* State Reports : Taxation, Property, etc. 
t State Reports, 1855-1865. 



352 STATE BOARD OF HEALTH. [Jan. 

It is impossible, from the returns, to make corrections for 
this repetition, although the separate town reports and the 
county summaries give the values of the materials used, leav- 
ing it to be inferred that the remainder of the production is 
to be accredited to labor, rents and interest, yet this is 
generally for individual articles, of which in this respect no 
summary is given. In some manufactories the cost of the 
new material is large in comparison with that of labor. 



The material of clothing costs 

Goods made, 
Boot aud shoe stock, 

Goods made, 
Woollen stock, 

Goods made, 



$11,000,000 
17,000,000 
35,000,000 
53,000,000 
35,000,000 
52,000,000 



In some others, the cost of material was about half the 
value of goods made, and others the labor was the main cost 
of the whole. 

In farming the production is given with no cost of material. 
For want of an exact statement it may be safe to give $300,- 
000,000 as the approximate amount of labor expended in the 
productions of these $517,000,000 in 1865. 

But it must be further considered that this includes only 
the labor expended on visible articles of vegetation or manu- 
facture. Even in these employments there are many occu- 
pied whose labor sends no products nor wares to market. 
The repairs of buildings employ many carpenters, masons 
and painters. The repairs of vehicles and harnesses gives 
occupation to many coach and harness makers. Jobbing 
blacksmiths, tinmen and many other mechanics render great 
service to the community, which does not enter these records. 
There are manifold mechanic shops which are not establish- 
ments, and are not included in the report. No note is taken 
of tailors, dress-makers who go from house to house, nor 
of personal and household service, the men and women of all- 
work ; the cook, the washerwoman, the hostler, the day la- 
borer, the stone-wall builder, nor of the laborers on public 
works, railroads, highways, streets, building making and 
repairing; nor of all the earnings of hotels, boarding-houses, 



1874.] STATE BOAKD OF HEALTH. 353 

of professional men, of teachers. These occupy no small por- 
tion of the people, who create value in their respective ways. 
Their earnings are not, and cannot well be, stated in the form 
of this report; but if added, they would very greatly swell 
the gross amount, and carry it with the earnings therein indi- 
cated up to the full $517,000,000 given. 

Eelation of Laboe and Capital. 

All this capital, $991,000,000 in 1865 and $1,696,000,000 
in 1872, in Massachusetts, is intrusted to the care of the effect- 
ive classes, who utilize it, and produce the value already stated, 
earning thereby sufficient for the sustenance of themselves 
and their families, and to increase the capital of the Common- 
wealth over $400,000,000 in the five years, 1865 to 1870, and 
$279,592,590 in the two years next following, 1870 to 1872. 

The production by human agency is very great in propor- 
tion to the capital, and both production and capital increase 
rapidly. 

In the ten years, 1855 to 1865, the production increased 
75 per cent. In the ten years, 1861 to 1871, the value in- 
creased 73.79 per cent, and in the five years, 1865 to 1870, 
this increase was 42 per cent. The amount of production 
accomplished by those within the laboring period, abridged 
and burdened with sickness and disability, indicate the amount 
of vitality, health and strength enjoyed by them between early 
maturity and the beginning of old age. 

Moral Aspects of Health. 

In this paper, thus far, account has been taken only of the 
productive power of the people, and this is measured by the 
length of the effective period which they enjoy, and their 
financial results. These are the only facts in this connection 
which are recorded and given to the world. They are the 
only reliable means of comparing the ideal and desirable life 
with the actual experience. They are the facts on which 
states and governments necessarily rely when they estimate 
their own worth and power, and when they compare them- 
selves with each other. 

Man's physical energy and power of creating property, as 
thus described, although the most necessary element in his 

45 



354 STATE BOAKD OF HEALTH. [Jan. 

earthly being, is not the whole of human life. But in this 
connection, with its gains and its losses, it may be taken as 
an indication of the proportion of comfort and happiness that 
is enjoyed or lost through his other and higher elements con- 
nected with the intellectual and moral nature. The pleas- 
ure of mental and spiritual culture, of domestic and social 
affections, — all that elevate man above the earth, — are not to 
be measured by the financial scale ; but they are measured by 
their opportunity and duration, which are the same for them 
as for labor. All of man's enjoyments, both physical and 
spiritual, in this life, are multiplied by lengthened years and 
diminished by premature death. 

It is natural for all men and women of sound mind to hope 
to possess a fulness of life, and to retain their strength to the 
last years of old age. 

Man is a religious being. Eesignation to the will of the 
Creator is a prominent element of his spiritual nature. He 
accepts the conditions of life, — seemingly established beyond 
power or expectation of change, — and he looks for death, at 
any moment, from the first, when infancy dawned, to the last, 
when a century or more of years shall have passed over him 
here. When his friends are taken from him, he submits to 
the unalterable decree with mingled sorrow for the loss and 
thankfulness that so much had been granted. Nevertheless, 
all hope for length of days, for complete development and 
maturity, and for the full opportunity of labor in their strength, 
and for deferred and protracted old age, and that they may, at 
length, lay themselves down to rest after having done all of 
life's work, and enjoyed all of life's blessings, that earth can 
afford. 

Interest of the Government in Health. 
It is manifest, then, that the first and largest interest of the 
State lies in this great agency of human power, — the health of 
the people. Herein is all its strength. This creates and 
manages all its wealth, and the chief responsibility of the gov- 
ernment is to protect it and, if possible, to enlarge it and 
make it more and more productive. But here the govern- 
ment, the representative of the State, very naturally asks what 
it can do in this matter. There is apparently no way nor op- 



1874.] STATE BOAED OF HEALTH. 355 

portunity for its interference. It would gladly prohibit fevers 
and all other diseases, if it would have any effect. It pro- 
hibits theft and murder, and is generally obeyed. But here 
it feels powerless. It cannot prevent the attack of sickness, 
nor resist its destructive force. It cannot arrest the hand of 
death, nor prolong human life by any act of legislation. All 
this is in the hands of a higher power, whose messenger is 
disease, and whose agent is death. What and where, then, 
is the responsibility of the State for the health of its mem- 
bers? Whatever may be the interest in, or sympathy with, 
the suffering and the sorrowful, when health fails or life is 
taken away, it is powerless before the causes, and, with the 
mourning people, must bow in submission to the fiat of the 
inevitable. 

There is a double error in this reasoning. First, life is not 
a fixed quantity to which it must come, and beyond which it 
cannot pass ; second, the body politic, both in this and in 
rtner countries, sometimes directly and sometimes uncon- 
sciously, has interfered in this matter, and life has thereby 
been expanded, strengthened and prolonged. 

The laws and conditions of life, in all its manifestations, — in 
vegetable, in. animal, in man, — are determined, and cannot be 
changed ; but the circumstances which surround life, and the 
measure of conformity to the appointed conditions, are infi- 
nitely various, and the degree to which life is developed and 
sustained is in accordance with them. 

Agkicultuke. 
For ages, one of the greatest studies of mankind has been 
to know exactly the laws which nature has established for the 
life of vegetables, plants, grains, fruits, roots, and of animals, 
cattle, sheep, fowls, and to learn and adapt the uecessary cir- 
cumstances to these requirements. So far as people have been 
successful in this search, and faithful to their knowledge, they 
have developed a larger life in this field of culture. Hence 
we have better, stronger and more useful cattle, larger and 
more nutritious grains and fruits for human sustenance, and 
better and richer herbs and grass for the support of domestic 
animals. The original apple, as offered by nature to man- 
kind, was the small, sour, bitter crab of the forest, unpleasant, 



356 STATE BOARD OF HEALTH. [Jan. 

indigestible, innutritious. By diligent and intelligent culture, 
it has grown to be hundreds of delicious and nutritious vari- 
eties. The pear, the peach, the plum, grapes and berries, have 
had a similar development from beginnings as humble and un- 
promising. Potatoes, beets, parsnips, beans and manifold 
other garden vegetables, have a similar history from small 
originals, through gradually increasing expansion, to their 
present richness and worth in the scale of nutrients. Fowls, 
sheep, swine, cattle, — all the varieties of animals which man has 
taken under his care in their present state, — have advanced as 
much from their primitive condition as the vegetables. One 
hundred and sixty years ago, in 1710, Dr. Davenant, a writer 
on political economy, estimated that the average weight of 
dressed cattle did not exceed 370 lbs., and that of sheep 2S 
lbs. In 1795, a committee of parliament stated that these 
animals had increased one-fourth in weight and size within 
fifty years. In 1846, McCulloch stated that, "at present the 
average weight of cattle is estimated at or about 800 lbs., 
and that of sheep at or about 80 lbs." "The weight of these 
animals has a good deal more than doubled in a little more 
than a century." * 

Whenever it has suited the purposes of man, and he has 
used the appropriate means, the strength of horses and cattle, 
and all their available qualities, have been increased, and they 
have become more and more useful to the world. 

Thus, agriculture and horticulture, in all their varieties, are 
neither more nor less than the culture of the living principle 
in some of its forms, the adaptation of circumstances, and 
supplies to the necessities of each beast, fowl and insect, each 
plant, grain and leaf, and giving them their appropriate means 
and opportunities of growth. 

Increase of Human Lite. 
Man, himself, has happily followed in the same path of im- 
provement. By better adaptation of means, circumstances 
and habits, his life has been expanded, his strength increased, 
and his days on earth prolonged. By the improvements in 
agriculture and in vegetable and animal life, he has obtained 

* Account of the British Empire, II., p. 515. 



1874.] STATE BOARD OF HEALTH. 357 

better and more constant food, and is therefore better nour- 
ished. By the improvements in the arts, he is better clothed 
and housed, better protected from the elements. The prog- 
ress of civilization is best manifested in the progress of vital- 
ity. There is less sickness, and that which visits humanity is 
less destructive than in former ages. 

The records of these most important facts are unfortunately 
few ;«yet these all concur in their testimony to the increase of 
man's longevity. 

In ancient Rome, in the period two hundred to five hundred 
years after the Christian era, the average duration of life in 
the most favored class was thirty years.* In the present 
century, the average longevity of persons of the same class is 
fifty years. 

The records of life and death in Geneva, in Switzerland, for 
the last three hundred years, are more complete than any 
others now known. These show that the expectation of life 
from birth, or the average longevity, was — 



21.21 years 

25.67 " 
33.62 " 
39.69 « 

40.68 " 



in the 16th century. 
17th " 
18th " 
from 1801 to 1833. 
1814 to 1833. 



In the 16th century, 25.92 per cent, of the children died in 
their first year. In the 19th century, the deaths at this age 
were reduced to 15.12 per cent. 

In the 16th century, 61.11 per cent., and in the present 
century only 33 per cent., perished before they reached ma- 
turity at twenty. 

In the first period, 3.08 per cent, passed their threescore 
and ten years, and in the latter 17.94 per cent, had that 
length of life. 

As large proportion now- live to seventy as lived to forty- 
three, three hundred years ago.f 

* Ulpianns quoted in Pandectas Justiniani, Lib. 35. Tit. 2. Ad legem Falcidiam. 
f Mallet in Annales D' Hygiene, XVII., 169. 



358 STATE BOAKD OF HEALTH. [Jan. 



British Tontines. 

In 1693, the British government borrowed money by sell- 
ing annuities on lives from infancy upwards, on the basis of 
the average longevity of the people of that century. The 
treasury received the price and paid the annuities regularly 
as long as the annuitants lived. The contract was satisfactory 
to both parties. The government obtained the money at a 
reasonable cost, and the annuitants received their principal 
and a fair interest, and no more. 

Ninety-seven years later, in 1790, Mr. Pitt issued another 
tontine or scale of annuities, on the basis of the same expecta- 
tion of life as in the tontine of the previous century. 

These latter annuitants lived so much longer than their 
predecessor, that it proved to be a very costly loan for the 
government. It was found that while 10,000 of each sex, in 
the first company of annuitants, died under the age of twenty- 
eight, only 5,772 males and 6,416 females in the second com- 
pany died at the same age, one hundred years later. The 
annuitants of 1693 enjoyed an average life of twenty-six years 
and six months. Those of 1790 lived thirty-three years and 
nine months after they were thirty years old. Within the 
century, included in this history, the longevity of this class 
of people increased twenty years.* • 

In Sweden the expectation of life at birth was thirty-five 
years and three months from 1755 to 1775. It was forty-three 
years and five months from 1841 to 1855. The average deaths 
were one in 36.2 of the living from 1746 to 1767, and one in 
47.3 from 1842 to 1855. f 

In France, of 1,000 born, the survivors to twenty, in 1781, 
were 458 ;J in 1806 they were 558, and in 1861, 628. § One 
million births in 1746 would support a constant population of 
35,938,543, and in 1865 39,815,520. || Moreau de Jonnes, 
says, "The improvements in nutrition among the people of 



* Dr. Southward Smith, in Trans. Brit. Social Science Assoc, 1857, p. 

f Befolknings Statistik, 1851-55. 

J Buffon's Works, II., 515. 

§ Legoyt Mouvement de la Population, 1861-65, p. xci. 

|| Ibid., p. xcii. 



1874.] STATE BOAED OF HEALTH. 359 

France have reduced the mortality one moitie. The mor- 
tality was one in 25 in 1782, and one in 43 in 1861 to 
1865.* 

A similar diminution of death and prolongation of life has 
been granted to other nations in the progress of civilization. 
The marked effect of the improvements in life is seen in the 
increased proportion that reach maturity, and of the effective 
population between twenty and seventy. The dependent class 
is thereby diminished and the sustaining class is increased. 
According to the Genevan record, the average working period 
has increased from eight years and five months to twenty-two 
years and eleven months within three hundred years, and con- 
sequently old age is postponed. Those who were formerly 
old at fifty and decrepit at sixty, are now old at seventy 
and decrepit at eighty, f 

From these facts, it is plain that life, in many forms and 
manifestations, and probably in all, can be expanded in vigor, 
intensity and duration under favorable' influences. For this 
purpose, it is only necessary that the circumstances amidst 
which, and the conditions in which, any form of life is placed, 
should be brought into harmony with the law appointed for its 
being. By this means the intelligent world has been and is now 
continually adding to the vitality of the vegetable and animal 
kingdom, as far as they are brought under their control. 
Man has increased his own life, also, in as far as he has con- 
formed his self-management to the requirements of the vital 
law. 

Beyond the pale of man's intelligent aid, life is apparently 
stationary. So far as human observation has gone, the wild, 
uncultivated plants, the trees of the forest, the grass of the 
meadows, the flowers of the untouched wilderness, the fishes 
of the sea, the birds of the air, insects, reptiles, wild beasts 
of the desert, left to their own instincts, are no larger nor 
stronger ; they have no more vital force or longevity than in 
the beginning of their race on earth. 



* Peuples d l'Antiquite. 

f Calculated from Mallet in Annales D'Hvgiene, XVII. 



360 STATE BOARD OF HEALTH. [Jan. 

Influence and Power of the Government in 
Agriculture. 
In most, if not all, civilized nations, the government, which 
is the concentrated wisdom of the people, has taken an espe- 
cial interest in agriculture, and lent its aid in the promotion of 
its prosperity. In Massachusetts it has encouraged the forma- 
tion and efficiency of agricultural societies, through which 
it has wielded great influence on the improvement of the pro- 
ductions of the farm and garden. The legislature makes 
annual appropriations, amounting to nearly thirty-four thou- 
sand dollars in this and the previous year. Nearly eighteen 
thousand dollars is given to the various agricultural societies, 
and is distributed by them in premiums for excellence in cult- 
ure and productions of the field and garden, etc. 

Board of Agriculture. 
A board of agriculture is established by the State, composed 
of the best agricultural talent and accomplishment in the 
Commonwealth. They have a secretary, a man of large 
power and acquirement, w T holly devoted to the work of his 
vocation. They have rooms in the state house, where is 
gathered a library of the best books, pamphlets and journals 
relating to farming, both American and foreign. These are 
offered freely for public use, and all who will, are invited to 
come and read or consult them. 

Agricultural Societies. 
There are thirty-one agricultural societies in Massachusetts, 
• in which probably every town is represented by some or many 
of its farmers. At their meetings and exhibitions, the best 
agricultural wisdom of their several districts is brought forth. 
The best plans of cultivation that have been suggested, ma- 
tured and tried on the farms, even in the obscurest corner, 
are there brought forth and the results exhibited. Specimens 
of the best products of the earth in every variety, grains, 
fruits, roots, whether grown for man or beast, are presented. 
These show what intelligence, skill and faithfulness can ac- 
complish in the development and expansion of animal and 
vegetable life ; and the methods used for these purposes are 



1874.] STATE BOARD OF HEALTH. 361 

described for the instruction of all. Thus the knowledge and 
experience of each is made the common property of the whole 
community. The best agricultural and horticultural lights 
are placed on the hill-top, so that all cultivators may be 
guided by them. 

Co-OPEKATION OF COLLATEKAL SCIENCES. 

The government enlists the cooperation of men of learning, 
scholars in all collateral sciences, philosophers, naturalists, 
botanists, chemists, mineralogists, geologists, ornithologists 
and entomologists. These investigate the nature and habits 
of plants, the character and re'ations of soils, the composition 
and power of manures, natural and artificial, and other ele- 
ments of vegetable nutrition, and their relation to the quantity 
and quality of crops. The habits of insects injurious to vege- 
tation, and of birds that are favorable to it, and the physiolog- 
ical character and pathological dangers of domestic animals, 
are all subjects of these scientific inquiries. Reports of great 
value to the agricultural interest are made on them, and mani- 
fold other topics connected with the cultivation of the earth. 

Some of these reports are printed by the State in separate 
volumes. Others, with essays on every variety of topics use- 
ful to the farmer, the discussions of the agricultural board, 
and the gatherings they draw in various parts of the State, 
and the reports of the agricultural societies are collected and 
published in annual volumes by the secretary, and distributed 
at the cost of the public treasury freely and gratuitously 
among the people. 

JThus the State has, in manifold ways, obtained the aid of the 
science of her scholars, and the practical wisdom of her culti- 
vators, to teach the best way of creating the largest life in 
plants and animals. The people have profited thereby. A 
marked effect has been produced on the public mind. Routine 
farming disappears ; thought, system and improvement take its 
place, under this liberal and sagacious leadership and encour- 
agement of the government. 

In this work the legislature and people have gone hand in 
hand, mind with mind, heart with heart, to effect their common 
purpose. Agricultural newspapers have sprung up in every 
part of the land. They find their way into a large part of the 

46 



362 STATE BOARD OF HEALTH. [Jan. 

farmers' houses ; they offer another and very wide opportunity 
for writers and experimental cultivators to teach their lessons. 
Those who take these papers profit by their instructions, and 
apply them to their daily practice. They learn, not for them- 
selves alone, but diffuse these blessings to their neighbors, so 
that few or none can avoid the light and influence of these 
journals. 

Farmers' clubs are formed in many towns, and hold earnest 
and profitable meetings. They are excellent schools of mutual 
instruction on the manifold topics connected with their voca- 
tion. 

These and other instrumentalities for the agricultural edu- 
cation of the people, here and elsewhere, have had so much 
influence that this interest has become a ruling power in the 
civilized world. It forms public opinion; it controls the 
habits and sensibilities of cultivators, so that they aim to de- 
velop and sustain the best animal and vegetable life, and feel 
ashamed of meagre cattle or unskilfully managed fields. 

Human Life Expansible as in Animals. 
Human life is subject to the same condition as the life of 
beasts that work for man, as that of the animals and vege- 
tables that supply him with food. The vital laws are equally 
determined in all living beings. Each has its own appointed 
requirements, and its vitality and power are in proportion to 
its opportunity to fulfil them. Intelligence of these laws, and 
conformity to them, produce the same effect in all, whether 
man, beast or plant. By means of this regard to the laws of 
their being, the vital energy of cattle, fruits, etc., is developed 
and sustained in high, perhaps in the highest, degree. But 
for the want of this regard, human vitality is incompletely 
developed and imperfectly sustained. Few of our cattle die 
in immaturity ; but many of .our children sink in this stage of 
their being. Man suffers more from sickness, in all his stages, 
than his animals, for whose health and protection he faithfully 
provides. A larger proportion of his race than of his horses 
perish in the middle and active periods of life, and a smaller 
proportion reach their fulness of years and die of old age. 



1874.] STATE BOARD OF HEALTH. 363 

Can Government Aid in Improving Human Liee? 

Is there room here in this field of human life for govern- 
mental cooperation as well as in the agricultural field of vege- 
table and animal life? It is powerful there. It is not power- 
less, and need not be ineffective, here. 

The power of the government is threefold, and is exerted 
in a triple way. 

It is mandatory, and says, thou shalt and thou shalt not. 

It is permissive, and grants privileges. 

It is advisory, instructive and encouraging. 

It teaches the people their best interests, and points the 
way of gaining them. 

By the second of these methods it has aided in the advance- 
ment of agriculture, — it grants money. But mainly in the 
third method has it done this great work. 

By all the three methods it has wrought its work in educa- 
tion. It has ordered a certain amount of schooling, in ratio 
of the population and the due facilities of houses, teachers, 
books, etc. It permits the people to raise more money and 
obtain for their children a higher and more liberal education. 

In the third method the government instructs, leads and 
persuades the people. By the board of education, the nor- 
mal schools, teachers' institutes; by enlisting the aid of the 
talent and learning of scholars, who can write and speak; by 
the reports in which are condensed the wisdom and experi- 
ence of the teachers throughout the State, — by all these and 
other means the State has created such popular sentiment, 
that the people, in all the towns and districts, demand and 
support schools of high order, in which every child may be 
taught and fitted for usefulness in the world. 

Yital Legislation. 
The government of Massachusetts has been accustomed, 
from its early periods, to take cognizance of public health, 
and has endeavored to protect the people from some of the 
causes of injury. The law offers some protection against 
contagious diseases, small-pox, etc., and also against nuis- 
ances, offensive trades, etc. In some degree it proposes to 
regulate tenement-houses ; it endeavors to save children from 



364 STATE BOARD OF HEALTH. [Jan. 

the exhaustive effect of over-labor in factories ; it authorizes 
hoards of health to abate nuisances of wet and foul lands, etc. ; 
and, lastly, in the creation of the State Board of Health, and 
endowing it with ample authority, it has taken large and very 
wise steps in this direction. All these show that the govern- 
ment recognizes its interest in, and responsibility for, the 
health and working power of the people, and its determination 
to lend its authority for their promotion. 

So far, these laws have had some effect in some places, but 
they are ineffective in others. There are manifold sanitary 
evils yet to be abated. The work ass r gned to the Board of 
Health has been prosecuted with great energy, and, as far as it 
has been able to go, with signal success. But ages must 
elapse before the single hand, authorised by the law, can 
accomplish the herculean task assigned to it, and required by 
public necessities. The field of human life is everywhere 
spread about us, and the harvest of tares and weeds is ready 
for the sickle, 'but the laborers appointed, though skilful and 
diligent, are very few. 

European Sanitary Legislation. 

Some of the European governments watch over the health 
of their people with jealous and anxious care, and endeavor to 
surround it with all the safeguards that modern science can 
suggest. They find many sanitary evils, which are the growth 
of ages, that have come down from the periods of barbarism. 
These are rooted in the habits and conditions of the people, — 
in the physical condition of the earth, — in the structure of 
cities, — in the locations of towns and dwellings. They seem 
to be an almost inseparable element in the social organism. 

The British parliament are singularly alive to this work, 
and have ordered many inquiries as to the health of the people ; 
and, led by the reports of their sanitary officers and commis- 
sions, many laws have been enacted for the benefit of public 
health. In the annual lists of laws that are passed, these are 
very prominent : — 

1839. Metropolitan improvement act. 

1840. Chimney-sweepers act. 
Bakehouse regulation act. 
Print-works regulation act. 



1874.] STATE BOARD OF HEALTH. 365 

1840. Dyeing-works regulation act. 

Passengers act. 
1841. • Vaccination act. 
1843. Vaccination act. 

1846. Fever in Ireland act. 
Baths and wash-houses act. 
Nuisance removal act. 

1847. Towns improvement act. 
Baths and wash-houses act. 

1843. Health of towns act. 

1849. Nuisance removal and disease prevention act. 

1850. General board of health act. 

1851. Interment act. 
Lodging-houses act. 

1852. Smoke nuisance prevention, in London, act. 
General board of health act. 
Vaccination extension act. 

Eegistration of births, marriages and deaths, in Scotland, act. 

Public health act. 

Nuisance removal and disease prevention act. 
1854 and 1855. Burial-grounds, iu Scotland, act. 

Public health, supplemental act. 

Burial grounds, in Ireland, act. 
1856. Nuisance removal act. 

Smoke nuisance abatement act. 
1862. Eegistration of births, marriages and deaths, in Ireland, act. 

Vaccination, Ireland. 

Vaccination, Scotland. 

Drainage, in London, act. 

Nuisance removal act. 

It is manifest from these titles, taken from the lists of a few 
years, that the British government take a very deep interest 
in sanitary matters, and are willing to make great efforts in 
their behalf. 



The Improvement of Towns in England. 

The most important and effective legislation in this direction 
inclndes the several laws, both general and special, authorizing 
the local governments to drain certain wet districts in the 
country, and to make improvements in the cities. Under the 
authority of these laws, many towns widened streets and lanes, 
opened courts, made sewers, paved highways, removed families 
from cellars, destroyed unfit habitations, swept and washed 
the filthy pavement, cleared away the micldensteacls or col- 
lections of animal excretion and refuse ; they filled low and 
muddy places, and made these streets and neighborhoods dry, 



366 



STATE BOARD OF HEALTH. 



[Jan. 



clean, airy and healthful, — consequently sickness diminished, 
the rate of mortality was reduced, the average age at death 
was increased. The people were stronger, more active, 
buoyant and cheerful ; they earned a better sustenance ; the 
numbers of paupers, both in and out of the workhouses, were 
lessened, and the poor-rates were less burdensome. 

The records of very many of these improvements, in vari- 
ous towns, together with the rates of mortality for series of 
years before they were made and after they were completed, 
are published, and show that there was good reason for be- 
ginning them, and that great increase of health and life fol- 
lowed them. 

In nineteen towns the annual mortality, which had been 28 
in 1,000 living for years previous to the improvements, fell to 
21 in 1,000 for the years afterward. In these towns the 
average annual deaths were 3,276 less after than before the 
cleansing of these places. So many lives were yearly saved.* 
In Macclesfield the average longevity was increased 20 per 
cent, by these means, j In Liverpool the rate of mortality 
was 38.4 in 1,000 before the authorities made the sanitary 
changes in the streets, cellars and other dwellings, and 26 in 
1,000 afterward. 

Latham, in his admirable treatise on. " Sanitary Engineer- 
ing " (p. 10) , quotes the results of the improvements in twelve 
towns, of which the following are the most prominent : — 





Deaths 


in 1,000. 




1 Eeductioxs— per cext. 








Saving 
of Life- 






TOWNS. 


Before 


After 








Improve- 


Improve- 


per cent. 


Typhoid 


Consump- 




ment. 


ment. 




Fever. 


tion. 


Cardiff, .... 


33.2 


22.6 


32 


40 


17 


Croydon, 


23.7 


18.6 


22 


63 


17 


Merthyr, .... 


33.2 


26.2 


18 


60 


11 


Newport, 


31.8 


21.6 


32 


36 


32 


Salisbury, 


27.5 


21.9 


20 


75 


49 



These sanitary improvements, in these and in many other 
towns, were universally followed by such increase of health 



* Cowper in Social Science Transactions, 1859, p. 113. 
f John May in Trans. Social Science, 1857, p. 403. 



1874.] STATE BOAKD OF HEALTH. 367 

and strength, and such reduction of mortality, that Mr. Chad- 
wick, formerly secretary of the National Board of Health, 
says that a sanitary " engineer ought to contract for the reduc- 
tion of the sickness and death-rate, in such a city as Glasgow, 
by at least one-third for a penny a head of the entire popula- 
tion." * The same good results followed the draining of coun- 
try districts, in some of which the annual deaths were reduced 
from 2.6 to 2.1 per cent, of the population. 

The whole of this experience in many cities and districts, in 
Great Britain, abundantly proves that the way is open in this 
sanitary field for the interference of the government, and the 
reward, in the increase of life and strength, is very great 
and sure. 

The sanitary dangers in the country are due, in great meas- 
ure, to natural causes, wet and marshy ground, unhealthy 
dwelling sites, etc. But in the cities they are mostly due to 
the faults of the people, to bad engineering, bad arrangement 
of streets and courts, and worse habits of the inhabitants of 
the foul districts,. and to the neglect of the local authorities. 

As, in all the civilized world, cities constitute so # large and 
increasing element of the nation, and as there is a tendency 
of the poor, ignorant and careless to crowd together in the 
pestiferous centres, it is the duty as well as the interest of 
the government to exe.cise an unceasing vigilance to prevent 
the establishment of such unhealthy conditions of street, 
court and house. And, if unhappily they already exist, the 
necessity is imperative that the authorities redeem the people 
at once from their destructive power. 

Geowth of Cities. 
Here in the United States, as elsewhere, is a constant 
tendency of population to gather in dense masses. The cities 
absorb the young and middle-aged from the country, and grow 
at its vital cost. In Massachusetts towns with 10,000 and 
more inhabitants heel 6.8 per cent, of the whole population 
of the State in 1800, 22 per cent, in 1840, and 48.7 per cent. 
in 1870. f The rate of increase of population of the cities 
and of the rest or country part of the State was : — 

* Social Science Transactions, 1866, p. 580. 
t Calculated from the census. 



368 STATE BOAED OF HEALTH. [Jan. 





Cities. Country. 


1800 to 1820, . 


18.7 per cent. 4.4 per cent.* 


1820 to 1840, 


110.9 " 20.4 


1840 to 1860, 


109. " 45. 



Mortality or City and Country. 

The cities not only grow at the cost of the country, but they 
exhaust human life more rapidly. Sickness is more preva- 
lent and fatal in the dense than in scattered populations. 
In England, among the same numbers of people living in the 
towns than in the rural districts, the deaths were many more 
from every class of diseases except two in the towns than in 
the country (from the class of zymotic diseases supposed in 
great proportion to be due to removable causes). They were 
nearly twice as many in the dense as they were in the scat- 
tered population. The proportion of deaths from old age, 
which are significant of health and longevity, were 37.7 per 
cent, greater in the country than in the great towns. Of the 
whole ninety-five causes of death specified in the Eegistrar- 
General's Keport, only fourteen, and these among the least 
destructive, were more prevalent in the country. 

From the whole number of diseases the deaths were 40 per 
cent, more in town than in country, or as often as 100 died 
in the rural districts 140 died among the people of the cities, f 

Tables in the sixteenth and supplement to the twenty-fifth 
reports of the registrar-general show the ratio of deaths in 
each of the six hundred and twenty-three registration districts 
and the density of the population, for twenty years. It is 
seen from these, that the death-rate keeps almost constant 
pace with the increasing density. In the most crowded dis- 
tricts, where 250 live on one acre of ground, one in eighteen 
died ; and in the country, where there were twenty to thirty- 
eight acres to a person, the death-rate was one in sixty-two. J 
Similar statements are made in the thirty-four annual reports 
of mortality. 

The report of Mr. Chadwick on the sanitary condition of 
the laboring classes in 1842, the report of the health of towns 



* Calculated from the census. 

t Condensed from Registrar-General's English Reports. 

% Supplement to Registrar-General's 25th Report, p. xxxviii. 



1874.] STATE BOARD OF HEALTH. 369 

commission in 1844, the reports of the Board of Health, — all 
confirm the statement that vital force is developed in a lower 
degree, and sustained in less vigor, and that life is shorter in the 
city than in the country. Both British and French army 
authorities state that a much larger proportion of the recruits 
for the army were rejected for want of strength, constitution 
or sufficient height anions: those enlisted in the towns than 
among those that came from the country. 

A lower physical vital power generally characterized the 
civic population of Great Britain and in the foul spots the 
depression was very great, sickness was abundant and life 
very short. 

American Cities. 
These pestiferous centres of disease and death are not 
peculiar to the old cities of Europe. We have them here in 
this newer country. The board of health discovered and 
revealed them in New York. Dr. Draper found them in Bos- 
ton, and even in some of the little cities of Massachusetts, that 
within a generation were open country villages. These need 
the vigorous arm of the law to purify them and make them 
fit for the residence of healthy and strong men and women. 

Government should Prevent the Creation of* Un- 
healthy Districts. 

The law now authorizes and commands the boards of health 
to make these reforms, at any pecuniary cost, for human life 
and strength are not to be weighed in the same scale with 
money. If the government can reform the unhealthy districts, 
remove their causes of sickness, open them to the fresh breezes 
of air, — if it can overcome these destructive influences after 
they are established, it can prevent them. If the law can 
upturn old and corrupted districts, and lay them out anew, 
favorably for health, it can lay them out according to this 
plan, when the fields are open, before the population gathers 
upon them. 

The health of towns commission appended to their great 
and valuable report, a series of propositions for the plan of 
all new cities, and the extension of all old cities. They 
required that all these should be laid out, measured, graded, 

47 



370 STATE BOARD OF HEALTH. [Jau. 

by a sanitary engineer, with strict reference to the health and 
power of the people that dwell on them. 

It would be a blessing to every city, and economy to the 
body politic, to make these conditions a necessary element in 
the organic law of every prospective city ; to require that its 
whole plan of streets, lanes, courts, and open grounds be made 
by such a sanitary engineer, and be ever afterward under his 
control. This would prevent the growth of those centres of 
disease and death, and those condensed hives of feeble popu- 
lation that now infest the old cities, and cost the municipalities 
so much to improve. This is legislation in the right direc- 
tion, and at the right time, where it will be most effectual. 
It offers to humanity protection against its sanitary foe before 
it appear^ and disarms it of power to do injury. 

The Law should make Steeets Safe for Dwellers as 
well as for travellers. 

The law already takes the streets under its care so far as to 
make them safe for the passage of travellers, teams and 
merchandise. It makes the municipalities responsible for all 
damage that may befall man, beast, wagon or freight, from 
defect in the pavement or hole in the highway. 

If the law can secure safe passage for travellers, carriages," 
merchandise in the thoroughfares, and make the towns liable 
for any damage to limb of man or beast, or to vehicle or 
freight from holes or obstacles in the highway, it may, with 
better grace, make the municipality liable for all suffering, 
fevers, dysenteries, withering of life and strength of the 
inhabitants, caused by pestilential emanations from the filthy 
pavement or sloughs in the passage-way. If the town be 
required to make the street wide and open enough for the 
passage of carts that bring coal and provisions, it may with 
more advantage to the families and the public, be required to 
make them sufficiently broad and permeable for the fresh air 
to reach and bring health and vigor to the dwellers on the 
border. The suffering, the loss of power from diseases which 
the exhalations from the uncleaned ground of these slums 
generate in the families that live in the houses near to them, 
are far greater, and cause more loss of time and productive 



1874.] STATE BOARD OF HEALTH. 371 

energy, than all that comes from injuries caused by physical 
imperfections in the street, lane and court. 

Interests of Human Life should hold Peecedence in 
all Legislation. 

In as far as human life is more important than all financial 
interests, arid even in the financial view, the creative power 
of human force is more valuable than all created capital, 
this cardinal interest of the people, individually and collect- 
ively, should take precedence of all other provisions, in all 
legislation. Every law, grant, or privilege from the legisla- 
ture should have this invariable condition : that human health, 
strength or comfort should, in no manner or degree, be im- 
paired or vitiated thereby. 

When the legislature grants the right to build a dam, and 
flow the waters of streams and ponds, the grantee is held 
responsible for all the damage that may be caused thereby to 
land's, crops and other mills. All this is well, for these may 
be compensated in money ; but besides this, he should be 
held responsible that no damage shall be caused to human 
life and comfort by the changes in the condition of the 
waters. This cannot be compensated by money. 

Factory Villages. 

Beside the large masses of population that are gathered in 
cities, there is a great tendency, promoted by civilization and 
increasing wealth and industry, to gather people in compact 
villages for manufacturing purposes. For the conveni- 
ence of access, and to save time, they live as near as pos- 
sible to the place of their occupation. Hence the dwellings 
of the operatives and the boarding-houses are often closely 
crowded in narrow streets, lanes and courts, and near to the 
water, sometimes on damp ground ; and, to euable the work- 
folk to live at as little cost as possible, these dwellings, in 
both village and city, are made to contain many lodgers, with 
little breathing-space. 

In Mr. Chad wick's report on the sanitary condition of the 
laboring classes, he states that though the operatives suffered 
sometimes from the close and impure air of factories and shops, 
they suffered more from the closeness of their homes, and 



372 STATE BOARD OF HEALTH. [Jan. 

the impurities of air and ground in and around them. Some 
manufacturers take extraordinary pains to make their facto- 
ries, and the dwellings and boarding-houses of their operatives, 
airy, healthful and invigorating. The Pacific Mills, of Law- 
rence, Mass., offer a noteworthy example of this sanitary 
arrangement, and find good return in the small amount of 
sickness and loss of time among their people. 

The silk factory at South Manchester, Connecticut, in which 
about a thousand people are employed, is situated in an open 
field of about five hundred acres. The halls, the rooms of 
the great factories and the shops are large, open, well ventilated, 
and lighted. Everything about them is enlivening and cheer- 
ful. The dwellings of the operatives who have families, 
and the boarding-houses of the others, are spread about on 
the lawns, separated from each other, with open grounds all 
around them. Everything is comfortable and attractive and 
tends to promote vigor and working power. The proprietors 
find that their benevolent and sagacious provision for the 
health and happiness of their work-people is well rewarded in 
their more constant strength, clearer brain, and more con- 
trollable and effective muscles. They do more and better 
work ; consequently, all connected with the establishment are 
more prosperous ; the company make larger profits ; the men 
and women earn more money ; and all add more to the income 
and capital of the State. 

The English laws offer many securities for the health and 
safety of the operatives in factories, and vigilant, ubiquitous 
inspectors watch closely for the sure fulfilment of these regu- 
lations. .The law of Massachusetts defends children from 
suffering from too early employment and excess of work in 
their tender years in these establishments, lest they be blighted 
in childhood and grow up to feeble and ineffective manhood 
^Vcc* and womanhood, and unprofitable members of the Common- 
wealth. 

The same humanity and public interest demand that the 
State protect these working-people, both young and old, at 
their homes, from the wasting influence of bad, damp, un- 
healthful locations and surroundings, from foul and pestilential 
streets and grounds, from noxious emanations sent forth from 
decaying material and artificial accumulation of waste matter. 



1874.] STATE BOARD OF HEALTH. 373 

Such sanitary provision should be made a necessary element 
of every law that incorporates manufacturing establishments. 
It should be made to reach and govern all collections of peo- 
ple, whether in city, town or village, whether for business, 
labor or dwelling purposes. In this way the State would 
take the first step to insure that every plan, enterprise and 
movement shall be begun and conducted without needless cost 
of human health and force, and without depreciation of the 
productive power of the people. In this way all legislation 
would hold first in consideration the Commonwealth's greatest 
interest, — the power of the people to create value and capital. 

Legislative Sanitary Committee. 

Our legislature always has various committees, consisting 
of men selected for their special intelligence, to watch over 
the several classes of public interest and see that they suffer 
no damage, and, more than this, to see that they derive the 
most advantage from the parental wisdom, care and power of 
the government. There are committees on education agricult- 
ure, manufactures, banks, insurance, finance, fisheries, rail- 
roads, mercantile affairs, towns, etc. 

The New York legislature adds to these a committee on 
public health. 

Such a committee, here and elsewhere, would find plentiful 
occupation in watching the effect of all laws on human health 
and productive force, in searching for causes of injury and the 
means of their removal or amelioration, and in providing 
securities for the future. 

Manner op Legislative Action. 
As a drowning man, or a child falling into the fire, demands 
help, prompt and energetic in proportion to the imminence 
and degree of the peril, so some sanitary dangers demand the 
immediate and efficient interference of the law, only to be 
measured by the importance of the matter that is at risk. 
When a person tampers with human life by adulterating food, 
or knowingly and selfishly offers to sell unwholesome articles 
of diet ; when he reduces milk with, water or adulterates it 
with foreign matter, and thus deprives children and adults of 
their due nutriment, or impairs their stomachs with indigesti- 



374 STATE BOARD OF HEALTH. [Jan. 

ble mixtures ; when men thus selfishly sacrifice the health 
and strength of others for their own gain, the law should hold 
this as a crime, as when one robs another of his property, or 
impairs his life and power with deadly weapons, and relax 
none of its severity until the destructive practice is overcome 
and the people assured of safety whenever they purchase milk 
or other provisions in the market or elsewhere. 

In all cases where life and health are in question, the arm 
of the government should be used with sufficient force to pro- 
tect them. A few years ago there was a very large establish- 
ment for boiling dead horses in the neighborhood of Boston. 
The flesh, with swill brought out of the city, was given to 
several hundred hogs in a piggery on the grounds. The odors 
from the processes and the hogs were very offensive to the 
neighborhood and injurious to their health. The town board 
of health remonstrated without effect. They complained to 
the grand jury. The proprietor was indicted for keeping a 
nuisance. The case was manifest and could not be denied. 
But he knew the mildness of the .law and the limit of the 
penalty. Weighing this against the profits of the business, 
he let the case go by default, paid the fine, and continued the 
work as before. It was more profitable to disobey than to 
regard the law. The law should not be thus set at defiance 
nor be bought off. It should never, in these questions of 
human health, be for the interest of the offender to persevere 
in his injurious practices. 

Fields of Sanitary Legislation. 
There are many fields for culture and operation in this 
broad sanitary region. They are as various as the habits and 
experiences of the people. The interests of health require 
unceasing vigilance of individuals in their self-management, 
and of the government in its watch over the conditions and 
influence that may affect them for good or evil. 

Nutrition. 
Animal life is maintained by a constant change of particles 
in the living body. We eat and drink two, three or four 
pounds of solid and liquid food in a day, and yet, after reach- 
ing maturity our weight is not materially increased. We 



1874.] STATE BOARD OF HEALTH. 375 

take into our bodies about a thousand pounds, half a ton, in a 
year, and yet at the end weigh no more than at the beginning. 
Our food, or whatever proportion of it is soluble in the 
digestive organs, is converted into nutriment of the blood, and 
whatever proportion of this is fitted for its ultimate purpose, 
is converted into flesh of various kinds in the several textures 
of the living body. The atoms of digested food thus become 
parts of the muscles, skin, fat, stomach, lungs, brain, nerves, 
bones, etc. When deposited in their new places, they are 
endued with the principle of life and with the peculiar and 
specific living powers of the organ or part to which it is 
attached ; in the muscles they contract, in the nerves they feel, 
in the brain they perceive, in the skin they receive impres- 
sions. In their several positions and connections they act 
and serve the purposes of life for a short period, and then 
they die, and are removed by an appropriate apparatus from 
their positions and other and new particles are brought to 
take their places, to live and work for a while and then give 
their places to their successors. After the}'' die they are 
carried out of the system through the lungs, the skin, the 
kidneys and bowels. As much thus goes out as comes into the 
living body. We are continually passing through a change 
in our internal structure. We are daily, hourly, momently 
dying, particle by particle, and as continually revived with 
the freshness of new life. This is nutrition. For this, new 
and appropriate materials in form of food must be constantly 
supplied. 

Food and Cookery. 
For this renewal of our bodies we ourselves provide the 
material, — dead flesh, meats, fowl, fish, bread, vegetables, 
fruit, etc. Nature takes what we offer her, digests it, if it be 
digestible, and converts it into flesh if it be nutritious. But 
nature is not indifferent as to the kind and condition of the 
material that is offered. The stomach will not digest all 
things alike. The nutritive organs cannot convert all matters 
into living flesh. The raw material, the food, must be selected 
in exact accordance with the powers of digestion and its fitness 
to be converted into flesh. It must be prepared and cooked 



376 STATE BOARD OF HEALTH. [Jan. 

in such a manner that the delicate organs of digestion and 
nutrition can use it for its intended purpose. 

This work of the purveyor and the cook, the selection and 
preparation of our food, requires more intelligence of its pur- 
poses and means of accomplishing them, more consideration, 
careful judgment and discipline, than any process submitted to 
human supervision. 

If the food be appropriately selected and suitably cooked, 
it is easily digested, and converted first into blood and lastly 
into flesh, then the body is well nourished and made strong. 
The eater enjoys a feeling of buoyancy and energy. He has 
possession of all his faculties, and is ready to apply them to 
effect his purposes. He thinks clearly. His muscles are 
ready for labor. His stomach does its work quickly, easily, 
and he is unconscious of its operations. 

But if the food be misadaptecl, if it be prepared in a manner 
unsuited to the stomach's power and the wants of nutrition, 
the eater suffers in various ways and degrees. He may have 
pains and oppression. The digestive powers may absorb an 
undue proportion of the nervous energy, and make him feel 
dull and heavy. His brain may be indisposed to action, and 
unable to carry on the mental operations. He is therefore 
more or less unfitted for labor or business, or the food may 
fail to supply the new atoms of flesh, in due proportion, and 
then the body is not renewed in the fulness of life, the mus- 
cles are not strengthened, the man is not refreshed. 

Much disease and disability, much distress and great loss 
of working power both in body and in mind, and even 
premature death, are brought upon us in consequence of the 
misadaptations by the provider and unfitting preparations of 
the cook. 

These, the provider and the cook, are our life-makers. 
We are in their hands, to make us what they can or will, — 
strong or weak, buoyant or depressed, active or sleepy, clear, 
bright, quick-witted, or dull and torpid, No office has such 
control over human power and effectiveness as that of # the 
housekeeper and the cook. There is none to which the Com- 
monwealth is indebted for so much of its energy. 

An office that wields so much power can be filled only by 
persons of high intelligence, appropriate culture and thorough 



1874.] STATE BOAED OF HEALTH. 377 

discipline. No office offers so wide and rich a field for the 
exercise of talent and scientific acquirement. No other posi- 
tion offers the opportunity for mind, heart and hand to pro- 
duce such large and desirable results. It is both a public and 
private misfortune that this office is not so considered and 
esteemed ; that the intelligent do not seek it, and the ambi- 
tious avoid it, and that consequently it is given up to the 
lower grades of intellect and culture. 

In the social and domestic organization of the civilized 
world, the men do the work and business abroad. They are 
farmers, mechanics, laborers, merchants, etc. The women 
are the housekeepers and provide and prepare the materials 
of life, or appoint those who do this in their stead, and be- 
come responsible in their office for the nutrition and thereby 
for the health and power of the family. 

The woman is not, by nature, a housekeeper or cook; nor 
is the man, by nature, made a farmer, mechanic or trader. 
But each has the capacity to learn the principles and details 
of the art or occupation which he or she may elect to. pursue. 
The man fits himself in youth for his future sphere of busi- 
ness, and takes the responsibility of its management only at 
maturity, after he has strengthened himself with knowledge 
and discipline for its burdens, otherwise he fails in his attempt. 
The woman often defers her preparation for her office as 
housekeeper until she assumes the responsibility, and some- 
times she accepts it while yet immature, undisciplined and 
unformed in character. If outward circumstances favor, she 
finds some other person to bear the most important part 
of her responsibility of providing and preparing the family 
nutrition. Generally this is performed by a deputy of the 
lower order of intelligence, who has no rational nor clear idea 
of the duty she undertakes or of the sanitary consequences of 
her operations. 

As a natural consequence of intrusting this all-important 
matter of human nutrition to such inadequate agencies, the 
preparations of food are often uncertain and unfitting for their 
purpose, and it is but a chance that they are adapted to the 
powers of the stomach or the necessities of the living organ- 
ism. Hence the common and very apt and descriptive con- 
gratulatory remark of the housekeeper, that " she had good 

48 



378 STATE BOARD OF HEALTH. [Jan. 

• 

luck with her bread," or the apologetic statement that "she 
was unlucky with her cake." 

A second, but necessary, consequence of the imperfect in- 
telligence as to the responsibilities of the kitchen is, that the 
family is sometimes oppressed by the labor of digestion and 
imperfectly nourished, and the final result is, that not unfre- 
quently they are not strengthened for work nor fitted for 
business, and then their efficiency is impaired and their product- 
ive energy is reduced. 

Nutrition of Domestic Animals. 
Our domestic animals are, and have been, more favored 
than their owners in respect to nutrition. Public attention is 
continually called to consider the best methods and means of 
strengthening and fatting them or fitting them for their 
intended purposes. So many are carefully studying their 
wants and the means of supplying them, — so much has been 
written in books, magazines, newspapers, in society reports 
and state reports, — such clear, philosophical and practical 
essays on these topics have been spread abroad by the agents 
of the government, — that most farmers are familiar with the 
best way of feeding their horses and oxenro develop their 
greatest . strength for work, their cows to produce the best 
quality or largest quantity of milk, their cattle and swine to 
produce the most flesh on their frames, — that, with all these 
aids, failure in these matters is very rare, while lean, weak, 
dyspeptic men and women and children are common. 

Purpose of Food not Generally Understood or Re- 
garded. 

Beside the inadequate nutritive supply for human necessities, 
there is a frequent lack of intelligence as to the real purposes 
of eating and the means of completely fulfilling them, and a 
general contentment with whatever may be offered from the 
kitchen. The eater's ideal of good food generally corresponds 
with the caterer's. Although good, digestible, nutritious 
bread is far from being universal (and it very generally falls 
short of the best standards in these respects), most people 
have the very comfortable belief that, at their own homes, 



1874.] STATE BOARD OF HEALTH. 379 

they have good bread, and pity their neighbors who are not 
so highly favored. 

There, is aj'go a very common sort of heroism or physiolog- 
ical stoicism in regard to eating. People often say, with self- 
complacency, that they can always eat whatever is set before 
them. They seem to think it unmanly or unwomanly to 
complain of their food. Not denying that they have special 
appetites, which they may indulge when suitable occasion may 
invite, yet to be particular Qg to their diet, and to give trou- 
ble to others on this account, appears to them to savor of 
selfishness and meanness. Their only principle is to fill the 
stomach with anything that is handy. Thus, while they feed 
their beasts and fowls, each for a specific purpose, — strength- 
ening, fattening, milking, eggs, — they feed themselves and 
their families according to the accidental convenience of the 
purveyor and the cook. 

A generous traveller, driving his own team, in cool weather, 
stops at a wayside inn, at noon, for rest and refreshment. He 
first cares for his beast. He sees that the horse is unharnessed, 
rubbed dry with straw, housed and blanketed. He directs 
the hostler to give first a little water and plentiful hay, and 
when the animal shall be sufficiently cooled and rested, to add 
grain and more water. Having done this, he goes into the 
house and takes such food as can be obtained, without much 
trouble to the family. 

A farmer in Massachusetts, of high intelligence in all the 
varieties of his vocation, watched all his animals unceasingly. 
He was familiar with their temperaments, habits and apparent 
wants, and fed them according to these idiosjmcrasies and his 
purposes concerning them. His working and fattening cattle 
and milch cows had different food, to promote their different 
ends. To one horse he gave oats, to another corn, and to a 
third meal with cut hay, because each worked better with the 
special kinds of food. He discriminated among his fattening 
pigs, and gave some potatoes and others meal, because they 
throve better with these respective diets. Nothing in these 
matters among his animals escaped his notice or was neglected 
by his judicious care. 

One day, meeting his physician accidentally, in the after- 
noon, and appearing to be in pain, he was asked as to the 



380 STATE BOARD OF HEALTH. [Jan. 

cause. He said that, for many months, he had felt great dis- 
tress and oppression for two, three or more hours after dinner, 
so that he was almost unfitted for work, and a*!w**nclay this 
was very severe, so that he usually lost the whole afternoon. 
He had the same in the morning after breakfast, but it was less 
severe. The physician inquired minutely as to the farmer's 
diet, and learned that the only constant article was brown 
bread (rye and Indian) , which he always ate freely at dinner 
and sparingly at breakfast, and *©onday he had Indian pud- 
ding. Hence arose his trouble. The Indian meal, which is 
ordinarily very healthy and digestible food, was not digested 
in consequence of some temporary weakness of his stomach. 
It fermented, turned acid, and gas w T as evolved, and produced 
distress and general depression. Following the physician's 
advice, he discontinued this bread and pudding, and had no 
more pain or debility, but was able to labor without inter- 
ruption or discomfort. 

This careful observer of his cattle and fowls, who ministered 
to each one's necessities, had not thought to watch himself, 
nor had he suspected that there would be any connection 
between his food and his suffering and weakness. He is an 
extreme illustration of the mental habits of a large part of the 
community as to their own nutrition and power and those of 
the beasts that they care for. 

Financial Estimate or the Office of the Cook. 

The price, in money, in the general market, or the financial 
value of any service, is a good indication of the world's esti- 
mate of its importance. 

Less is given to those who prepare our food than for most 
other service. The wages of a cook are much lower than 
those of the maker of our garments. The groom that feeds 
the horses is paid twice as much as the one w T ho feeds the 
family. The carpenter and the bricklayer, who build our 
houses, are paid as much for the work of a day as the women 
that build our bodies for the work of a week. 

According to the natural law, the character of the supply 
rises and falls in accordance with the estimate that is put upon 
it, and the reward that is paid for it, in this as in other occu- 
pations. The talent that can rise high avoids the food labo- 



1874.] STATE BOARD OF HEALTH. 381 

ratoiy, where it is meagrely paid, and goes to the clothes 
laboratory, where it is paid generously. The cook of little 
education and skill in her vocation, finds small inducement of 
better appreciation or higher wages to cultivate her talents 
and become accomplished in her art, as men and women in 
other employments, where respect and reward follow step by 
step closely upon improvements in taste and workmanship. 

Government Aid. 

Here it may be asked, What can the government do in this 
matter ? Shall it write a book on diet and cookery for the 
people? It has caused this to be done for domestic animals. 
The interesting and instructive State Agricultural Reports are 
bespread with admirable essays on the food, its material and 
preparation, for cattle of various kinds and purposes, — work- 
ing, milch, fattening ; and also for swine and fowls. The 
writers prove the excellence of their teachings in the results 
of their practice in the production of flesh, strength, milk, 
etc., and in the increase of vitality. One teacher, in the re- 
port of 1872, after describing minutely the material and the 
manner of the preparation of the food, said that "he had this 
year raised one hundred chickens without one case of sick- 
ness." * He does not say there were no deaths in his flock. But 
if there were no sickness none could be lost from this cause. 

Through all these annual volumes, issued by the State, we 
find these receipts, directions for the healthful nutrition of 
animal life, written by the agents appointed by the govern- 
ment or enlisted in the work by its influence. And although 
these sagacious and profitable teachers have given their lessons 
of wisdom for so many years, still they are not satisfied with 
the progress they have made. They are untiring in their 
investigations and teachings. Every volume is freshly laden 
with new wisdom, new instruction, as to the means and 
manner of nourishing animal life. 

By the use of similar agencies and instrumentalities, the 
government can begin, and in course of time accomplish, as 
large a work in respect to the people, as it has in respect to the 
cattle. It can create such a public sentiment that those who 

* Page 300. 



382 STATE BOARD OF HEALTH. [Jan. 

have the care of human nutrition, whether in themselves or in 
others, will be as eager as the farmers to learn the principles 
and practice of their vocation, and feel as responsible for the 
fulness and duration of life in men, women and children as 
the managers of domestic animals for the health and power 
of the beings under their charge. 

Insanity. 

Among the many interruptions to human effort and pro- 
ductive power caused by ill-health, insanity, which includes a 
wide range of mental disorders, stands prominent by its 
frequency and persistence. Under appropriate influences, 
insanity is among the most curable of grave diseases. If the 
persons who are attacked with this disorder are as promptly 
cared for as others wdien attacked with fever, dysentery, 
pneumonia, etc., 80 or 90 per cent, can be restored to health 
and usefulness. But if neglected, the disease tends rapidly 
to fix itself upon the brain, and becomes more and more 
difficult to be removed. If allowed to remain one year, the 
chance of restoration is materially diminished. In two years 
this hope is reduced more than half; and after five years' 
duration few are restored, and even then it is due to some 
unexpected turn of the disease rather than the result of heal- 
ing remedies. 

Not only is the chance of recovery lessened by delay of 
attention, but the time required for cure is greatly increased. 
The period of the healing power varies with many circum- 
stances and conditions, from a few days or weeks to many 
years. The average in the several hospitals in this country 
ranged from ten months and five days in the longest, to five 
months and three days in the shortest. In the Worcester 
Hospital it was 23.8 weeks, in the Northampton, 30 weeks, 
and in the McLean Asylum, 22 weeks ; the differences 
being due, in great measure, to the earlier or later attention 
to the cases by the friends. 

Under the power of this disease, the sufferer not only 
ceases to be a worker and to contribute to his own support 
and that of his family and the State, but he is a positive 
burden, for the cost of his sustenance and the care necessary 
for him in his wayward impulsiveness and uncertainty 



18.74.]- 



STATE BOAED OF HEALTH. 



383 



of conduct. He always requires supervision and guardian- 
ship. Some are violent, a few are dangerous, many, perhaps 
most, *nust be confined, or under the watch of discreet and 
faithful attendants. This is necessary for their own security 
and comfort, or the safety of the community. 

In the most favorable condition, the cost for care and sus- 
tenance of the insane is greater than that of the sound in 
mind, and with most, the expense is very much greater. 

Although insanity unfits its subjects for mingling with, and 
taking part and lot in the interests of, the world, it is not 
immediately destructive to life. Some lunatics live five, 
some ten, others live fifteen, and a few live forty and fifty 
years, while suffering from their mental malady. 

Mr. John LeCapelain, actuary of the Albion Life-insurance 
Company, in London, calculated the average longevity of the 
insane at the several periods of life, and determined the 
number of years that they would live after any age from 
twenty, thirty, forty, etc. This life-table of the insane in 
England compared with the life-table of the sane people, 
shows how much life is lost by uncureel insanity. 

The following table includes the mean number of years that 
the insane and the sane in England will live after speei- 
fied ages, according to the LeCflpelain Table and that of the 
English Life-Table by Dr. Farr :— 



Years of After-life from Ages. 





Males. 


Females. 


AGE. 


Sane.* 


Insane.f 


Sane.* 


Insane.f 


20, . 

30, '. . 

40, 

50, . . . . ' . 

60, 

70, 


39.48 
32.76 
26.06 
19.54 
13.53 
8.45 


21.31 
20.64 
17.65 
13.53 
11.91 
9.15 


40.29 
33.81 
27.34 
20.75 
14.34 
9.02 


28.66 
26.33 
21.53 
17.67 
12.51 
.8.87 



* English Life-Table, 1864, Dr. Wm. Farr, p. cli. 



t Mr. John LeCopelain's letter. 



It is seen from this table, that men twenty years old becom- 
ing insane, will have an average life of 21.31 years, if not 
restored to health. During this period, their families and the 



384 STATE BOARD OF HEALTH. [Jan. 

Commonwealth not only will lose their services and contribu- 
tion to their income, but they will be obliged to support 
them, at even greater cost than if they were in good mental 
health. On the contrary, if they be restored, they will have 
an average life of 39.48 years, during which they may labor 
for their own and their families' support, and add to the 
public income and capital. 

Cost of Restoring the Insane, 

The cost, of supporting the patients in the three state 
lunatic hospitals of Massachusetts, was about four dollars 
($4) a week, in the last reported year. The average time 
required for restoration is twenty-six weeks. Thus the 
average cost of restoring an insane person in our state 
hospitals is one hundred and four dollars, and a patient 
restored to health goes forth to the world. He has then an 
average life of 39.48 years before him, to labor for himself and 
the body politic. As merely a common laborer he can earn, 
at least, thirteen dollars a month, or one hundred and fifty- 
six dollars a year, beside his sustenance. 

If then he be not restored, he remains an unproductive bur- 
den on the private or the public estate of the Commonwealth, 
a consumer of his part or other people's earnings for 21.31 
years. At the lowest estimate, for the poorest and cheapest, 
this cost of board, clothing, care and rent for a lunatic, is 
three dollars a week, or one hundred and fifty-six dollars a 
year, which must be paid out of his own or family's estate, 
or the general treasury, weekly, monthly or yearly. 

On the other hand, if he be restored to health, he will 
contribute as much yearly or weekly to the general income 
of the Commonwealth. 

Here are the means of comparing the advantages and dis- 
advantages of properly caring for and healing the insane and 
of neglecting them. 

On one side is the cost of supporting a lunatic in the hos- 
pital for twenty-six weeks, the average period of cure, at 
four dollars a week — one hundred and four dollars in all. 
Even if we add for the cost of rent or interest on the value 
of the hospital, house and lands, etc., thirty dollars for each 
patient for his six months' occupancy, the whole average cost 



1874.] STATE BOARD OF HEALTH. 385 

amounts to one hundred and thirty-four dollars for the ex- 
pense of restoring a man from being a profitless burden and 
making him a profitable cooperator in the community. 

On the other side, if not restored, the community, or its 
members or its estates, becomes responsible for the payment 
of his board and support for 21.31 years at the lowest rate of 
one hundred and fifty-six dollars a year, and also loses his 
earnings of the same amount for 39.48 years. 

These two annually recurring sums, each of one hundred 
and fifty-six dollars, are practical annuities ; one, for the 
lunatic's support, must be paid by the State or its members for 
21.31 years ; and the other, the earnings which he would have 
gained for 39.48 years, is lost to the same parties. 

At five per cent, interest of money the annuity of the earn- 
ings, one hundred and fifty-six dollars for 39.48 years, can he 
bought of an annuity company for twenty-six hundred and 
sixty-five dollars and thirty-seven cents ($2,665.37). This 
is the present commercial value of a laborer twenty years old. 

The annuity of the cost of the support of the uncurecl luna- 
tic for 21.31 years can be bought for twenty-one hundred and 
forty-one dollars ($2,141). An annuity company will con- 
tract to pay this sum for this period for this amount. This is 
the present worth of the obligation resting upon the State 
or its people for the support of a neglected lunatic, beginning 
in his twenty-first year. 

The costs and the profits of healing lunacy may then be 
compared in the cases of laborers becoming insane at twenty 
years of age. 

Gain, present value of his future labor, $2,665 37 
Present value of the cost of his support 

if not healed, . . . . 2,121 00 



Total saved and gained, . . . $4,786 37 
Cost of healing, 134 00 



Net gain, $4,652 37 

On an average, a lunatic twenty years old, allowed to remain 
unhealed, entails a loss of $4,786 to the body politic and a 
gain of $4,652 if restored to health. 

49 



386 • STATE BOARD OF HEALTH. [Jan. 

If the patient be older, with a lesser duration of life before 
him, whether insane or restored to health, the cost and the 
loss will be proportiouably less. 

In the foregoing calculation no regard is paid to the ten or 
twenty per cent., who, from the nature of their malady, can- 
not be healed ; upon whom all hospital skill and efforts will 
be expended in vain. These must be supported in the period 
when the trial of remedy is made, either in the hospital or at 
home, and the cost in the institution is but little if any more 
than it is elsewhere. And considering the great burden of a 
lunatic in domestic life, the care and anxiety, the interruption 
to business, the lessened labor and production caused by his 
presence, it is safe to say, that the average cost of supporting 
and caring for the insane in private families is as great as it 
is in the state hospitals. 

The example quoted above is that of a common laborer, 
without skill, trade or profession, who earns thirteen dollars 
a month beside board, and whose board is three dollars a 
week. Mechanics, merchants, proprietary farmers, profes- 
sional men, etc., earn much more, if in health, and live at 
greater cost, if mentally diseased. They are worth more, 
the loss is much greater if their malady be not relieved, and 
the gain greater if they are restored. 

Economical Practice in some States, 
Several of the Western States, looking upon insanity in this 
economical light, and believing that for the good of the com- 
monwealth as well as for the sake of humanity, every men- 
tally diseased citizen should be restored to health and useful- 
ness, at any cost, open their hospitals gratuitously and bid 
all their families to send their lunatic members to be cured 
with the least loss of time or productive power. 

They find the double advantage that a much larger propor- 
tion t>f these patients are sent in the early and curable stage 
of their disease, and a larger proportion are restored, and con- 
sequently a smaller proportion are left in permanent lunacy, a 
life-long burden on the public or private property of the com- 
monwealth. 



1874.] STATE BOARD OF HEALTH. 387 

Burden of Insanity in Massachusetts. 

When the insane of Massachusetts were enumerated in 
1854 there were 2,630 in the State. Of these 2,007 were 
American, and 625 were foreigners. Eight hundred and 
twenty-four, or 41 per cent, of the Americans and 16 or 
2.5 per cent of the foreigners, had never had opportunity of 
healing in a hospital. 

If the proportion of the insane to the sane population con- 
tinued to be as large, there were 3,194 in 1870, and 
there are still more at the present time. In 1854 there 
were 2,018 or 76 per cent, incurable, 435 or 16 per 
cent, were curable, and nothing was learned of the pros- 
pects of 179. The incurables were those who had not 
been in any hospital, those who were not sent until their 
malady was immovably fixed, and lastly, those who had had 
an appropriate trial of the healing process, but whose disease 
was incurable from the beginning. Some of those, who, in 
1854, had never been in a hospital, were diseased past cure 
before the Worcester hospital was opened, in 1833. Most of 
these probably have passed away, and that class is reduced. 
A larger proportion of lunatics are now sent to hospitals, and 
more of these are sent in the early stages of their disorder. 
Still, many are kept back until their day of healing is past. 
Of the 1,019 admitted last year into the state hospitals, 489 
had been diseased a year, and 391 two years or more. The 
great majority of the last must remain insane for life. 

There is no record to show whether any, or how many, 
were deprived of all opportunity of treatment in the state 
hospitals. According to the last reports there were 1,006 
paupers and 298 paying patients belonging to Massachusetts 
in these establishments. Adding the lunatics in the McLean 
Asylum, the asylum at Tewksbury, and the receptacle at Ips- 
wich, there were 468 independent patients and 1,533 pauper 
patients in the institutions of this State. Beside these, the 
overseers of the poor reported 442 others in almshouses, etc., 
making 1,975 reported pauper insane in the State. It appears, 
then, that this class of patients are sufficiently well provided 
for. 



388 STATE BOARD OF HEALTH. [Jan. 

But the 468 independent patients under care indicate either 
that the self-sustaining families en'oy a remarkable immunity 
from mental disease, or, more probably, that but a small pro- 
portion of their lunatics are sent to the hospitals and a large 
proportion retained at their homes. 

As the self-sustaining families are as anxious that their 
insane relatives should be restored as the poor, it is worth while 
to inquire why so many of the latter class and so few of the 
former are found in the hospitals. 

The established charge in the state hospitals for private 
patients is five dollars ($5) a week, and more when circum- 
stances permit. 

A large proportion of the independent families, in this and 
all civilized States, earn a comfortable living only, and have 
no surplus. By diligence and good discipline of economy 
they have sufficient for all their common wants, and no more. 
To them the payment of two hundred and # sixty dollars a 
year, for the support of a member in a hospital, is nearly or 
quite impossible, and certainly a burden painful to be borne, 
and especially if that diseased member be one of the heads, 
who creates or administers the income. This class embraces 
professional men, — especially clergymen and teachers, — small 
farmers, mechanics, journeymen, small traders, etc., who 
constitute no small proportion of the people, to whom, or, at 
least, to many of whom, the state hospitals are practically 
closed by their inability to pay the appointed charge for board 
and care.* 

From the e and other causes, we have, in Massachusetts, 
about 3,300 lunatics, who are and must be supported at an 
average expense of three dollars a week, at least, for each, or 
$514,800 a year for all. Add to this the loss of their earnings, 
and the whole cost of the burden of insanity approaches a 
million dollars annually in Massachusetts. 



* Three unmarried sisters sustain themselves and, in great part, their aged parents, 
by their personal labor; one taught school, one is a book-keeper, and one a sales- 
woman in a store. Three years ago one of them became insane. They applied to 
one of the state "hospitals for admission, stating their pecuniary condition. They re- 
ceived answer, that the patient could be received for five or ten dollars a week. They 
could not spare five hundred and sixty dollars a year, nor even two hundred and fifty. 
They could not call themselves paupers and apply to the overseers of the poor. The 
patient was not sent. She is now insane for life. 



1874.] STATE BOARD OF HEALTH. 389 

Constant Recurrence of Insanity. 

The causes of insanity are many and various. They inhere 
in the constitutions of some. They are connected with many 
physical disorders and forms of vital depression. They grow 
out of perversions, excesses, abuses of the mental, moral and 
bodily powers, especially the appetites and lower passions. 
These vary in different periods, and with different people, yet 
in any population their united destructive force is about the 
same from year to year. 

The number of patients admitted to the hospitals, within 
any year, may be assumed to represent as many new cases of 
the disease. For although in the last year, and in the preced- 
ing year, many of the lunatics received had been diseased 
one, two, five, ten and more years, they left behind as many, 
who w 7 ill be presented to the hospitals when their maladies 
shall have been standing as long. Taking thus the annual 
admissions into the hospitals of Massachusetts as representa- 
tives of the number attacked, there was an annual average of 
953 new cases in the last six years, or one in 1,508 of our peo- 
ple were stricken down with insanity in each year. The pro- 
portions to the population were singularly regular in these six 
years, — 1867 to 1872, — being severally one in 1,546, 1,486, 
1,533, 1,350, 1,389 and 1,357. There was a similar regu- 
larity through many preceding years. During the war the 
proportion was less. The opening of each new hospital 
increased it. 

What has been will be, in the same conditions, unless our 
personal habits and exposures and our social customs change. 
A similar proportion of our people will annually become 
insane. And unless more effective influences be used to induce 
their friends to use the proper means of healing, or to draw 
them into the hospitals in the early and curable stage of their 
malady, a like proportion will be kept at home until their dis- 
ease is fixed beyond hope of removal, or deprived entirely of 
the opportunity of being restored, and be life-long burdens 
on the body politic. 

With this experience of the past, with this great and 
increasing burden on the income and capital of the people, 
considering how small the cost of restoration and how large 



390 STATE BOARD OF HEALTH. [Jan.'74. 

the cost of neglect, it is good economy' for the State to open 
its hospitals freely to every lunatic, and even compel every 
one to use these or other appropriate means for healing, and 
allow none to remain permanently insane except the small 
residuum whose mental disorders are, in their nature, incura- 
ble. 

Humanity as well as economy still further demands that the 
government lend its intelligence and its influence to discover 
the causes of mental disorder, and to lead the people from 
those paths of error and those pitfalls that have hitherto 
destroyed so many among them. 



jz. < < 

■ c<r - 

c ■ 



« << 



<;<<:. «e« 






■f cc 












r CS*£ < 



1 -t! *-^gS^~<l 






<<<<<< 






<: c<Si«E<Jej <z «K$<aCiC <«& 



mi- 



c <: ^ ' ^<" «- 

V code: c. «^< 

<: < <^t c <CK3 










i «c^< 



<cj^ 



C : (1< 6 C_ <CS1 <c OCX *~ 

«c<C<"<: <uv <:_/<-- ■■r<:<:^ ■,€.«— < S-. 

<C«CC 4 < <& <!:<>: ^Ops -_<:<> 
,- CC <£LO tC <CQ X^ <^J <<<C ^ ' CC^ 












; < f 


£& <c^ - ^<" 




<i <. v V v r < «^<^ 








^ . -C < ... r < « 






< 








C 




<.^ 


_t 





curctxc: 












..v-.'Cffj;,<: 



c: «ac 



<?"<jCI : 



^^ 



























